Healthcare Provider Details

I. General information

NPI: 1073443560
Provider Name (Legal Business Name): EASTON MARC WOLFE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

IV. Provider business mailing address

5206 REGENCY CV
AUSTIN TX
78724-5335
US

V. Phone/Fax

Practice location:
  • Phone: 855-782-7822
  • 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:
Title or Position:
Credential:
Phone: