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General NPI Number Information
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NPI Number | 1487042453
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Entity Type | Individual
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Provider Name | JILL OLDHAM
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Gender | Female
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 2307 HUNTERS GLN
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City | WICHITA FALLS
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State | TX
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Zip | 76306-1148
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Country | US
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Telephone | 972-467-2602
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14597
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City | ARLINGTON
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State | TX
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Zip | 76094-1597
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Country | US
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Telephone | 817-277-8870
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Fax | 817-277-8875
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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