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General NPI Number Information
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NPI Number | 1295372209
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Entity Type | Individual
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Provider Name | PATRICK CREAGH RBT
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Gender | Male
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 520 POINTE PARKWAY BLVD
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City | YUKON
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State | OK
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Zip | 73099-0600
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Country | US
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Telephone | 855-782-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 SW 120TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73173-8813
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Country | US
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Telephone | 607-221-8441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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