Provider Demographics
NPI:1205137734
Name:BREATH, WYAKIE S
Entity type:Individual
Prefix:
First Name:WYAKIE
Middle Name:S
Last Name:BREATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1421
Mailing Address - Country:US
Mailing Address - Phone:405-819-6827
Mailing Address - Fax:
Practice Address - Street 1:1031 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1421
Practice Address - Country:US
Practice Address - Phone:405-819-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst