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General NPI Number Information
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NPI Number | 1891684940
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Entity Type | Individual
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Provider Name | ELISA SANDERS
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Gender |
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 401 S COLTRANE RD STE 260
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City | EDMOND
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State | OK
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Zip | 73034-6722
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Country | US
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Telephone | 580-318-9415
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 E MAIN ST STE 1
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City | WEATHERFORD
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State | OK
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Zip | 73096-6030
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Country | US
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Telephone | 405-857-8280
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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-25-446705
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License Number State | OK
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