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NPI Code Detail

MEDICARE: ODILLIA KUNTUM

MEDICARE: ODILLIA KUNTUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1235096264
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODILLIA KUNTUM
Provider Business Mailing Address
First Line : 5816 ASHLEYANNE CIR STE 400
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76310-1613
Country : US
Telephone Number : 940-757-0660
Fax Number :
Provider Business Practice Location Address
First Line : 5816 ASHLEYANNE CIR STE 400
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76310-1613
Country : US
Telephone Number : 940-757-0660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2026
Last Update Date : 01/09/2026

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Directions to “ ODILLIA KUNTUM ” Practice Location

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