MRS. Reva Diane Ullom
NPI #1063068807 in Bridgeport, Ohio
Provider Information
- NPI Number
- 1063068807
- Entity Type
- Individual
- Name
- MRS. Reva Diane Ullom
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Behavior Technician
- Enumeration Date
- Aug 16, 2019
- Last Updated
- Aug 16, 2019
Practice Location
- Address
- 68583 SCOTT STREET
- City
- Bridgeport
- State
- Ohio
- ZIP Code
- 43912
- Phone
- (740) 298-7078
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Technician |
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