Provider Demographics
NPI:1558979724
Name:FITZPATRICK, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E 15TH ST STE 800B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6682
Mailing Address - Country:US
Mailing Address - Phone:405-455-6868
Mailing Address - Fax:405-562-3444
Practice Address - Street 1:1212 S AIR DEPOT BLVD STE 9
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4860
Practice Address - Country:US
Practice Address - Phone:405-455-6868
Practice Address - Fax:405-562-3444
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-20-10976106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician