MEDICARE: MRS. CRYSTAL ANN TONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1679952857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL ANN TONER

Provider Business Mailing Address
First Line	:	8100 ALFADALE ST
Second Line	:
City	:	UNION CITY
State	:	OK
Zip	:	73090-6617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 ALFADALE ST
Second Line	:
City	:	UNION CITY
State	:	OK
Zip	:	73090-6617
Country	:	US
Telephone Number	:	405-227-1879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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Directions to “ MRS. CRYSTAL ANN TONER ” Practice Location

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