MEDICARE: ABRAM BLALOCK

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1801587258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABRAM BLALOCK

Provider Business Mailing Address
First Line	:	6010 W BRITTON RD APT B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-2408
Country	:	US
Telephone Number	:	662-816-9471
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 W BRITTON RD APT B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-2408
Country	:	US
Telephone Number	:	662-816-9471
Fax Number	:

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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Directions to “ ABRAM BLALOCK ” Practice Location

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