Davi Blackthorne

NPI #1366142689 in Shawnee, Oklahoma

Provider Information

NPI Number: 1366142689
Entity Type: Individual
Name: Davi Blackthorne
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Mar 6, 2023
Last Updated: Mar 6, 2023

Practice Location

Address: 1336 N HARRISON AVE
City: Shawnee
State: Oklahoma
ZIP Code: 74801-5206
Phone: (405) 424-7711

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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