Provider Demographics
NPI:1891406419
Name:CRON, OCTAVIA (BT)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:CRON
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S DOUGLAS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5210
Mailing Address - Country:US
Mailing Address - Phone:405-582-3990
Mailing Address - Fax:
Practice Address - Street 1:1121 S DOUGLAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5210
Practice Address - Country:US
Practice Address - Phone:405-582-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician