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General NPI Number Information
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NPI Number | 1578422291
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Entity Type | Individual
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Provider Name | BRYCE TAYLOR BLASINGAME
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Gender | Male
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1817 COMMONS CIR STE A
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City | YUKON
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State | OK
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Zip | 73099-9522
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Country | US
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Telephone | 405-467-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 1824 COMMONS CIR STE B
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City | YUKON
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State | OK
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Zip | 73099-9538
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Country | US
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Telephone |
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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 | RBT-25-454284
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License Number State | OK
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