Healthcare Provider Details

I. General information

NPI: 1467316315
Provider Name (Legal Business Name): BLUESPRIG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LIBERTY LN
EDMOND OK
73034-9432
US

IV. Provider business mailing address

600 LIBERTY LN
EDMOND OK
73034-9432
US

V. Phone/Fax

Practice location:
  • Phone: 405-548-1029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: NATACHA CHARBONNEAU
Title or Position: BT/RBT
Credential:
Phone: 405-548-1029