Most Relevant Information
Provider Data
| NPI Number: | 1003415480 |
| Provider Name: | ZACH TEAGUE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/18/2020 |
| Last Updated: | 05/28/2021 |
Provider Practice Location
2248 NW 164TH ST
EDMOND
OK
730138801
Practice Location Phone/Fax
| Phone: | 4056052663 |
| Fax: | 4055623753 |
Provider Mailing Location
3517 NW 164TH TER
EDMOND
OK
730139471
Provider Mailing Phone/Fax
| Phone: | 4056052663 |
| Fax: | 4055623753 |