Most Relevant Information
Provider Data
| NPI Number: | 1003414194 |
| Provider Name: | BLAKE DAVIS |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/12/2020 |
| Last Updated: | 12/07/2022 |
Provider Practice Location
2208 W DETROIT ST
BROKEN ARROW
OK
740123629
Practice Location Phone/Fax
| Phone: | 9189006237 |
| Fax: |
Provider Mailing Location
2208 W DETROIT ST
BROKEN ARROW
OK
740123629
Provider Mailing Phone/Fax
| Phone: | 9189006237 |
| Fax: |