MEDICARE: SARA CAROLINE HIBBS

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
1	106S00000X	Behavior Technician	RBT-19-86153	OK
2	103K00000X	Behavior Analyst	1-21-53021	OK

General Provider Information

NPI Number	:	1477110682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA CAROLINE HIBBS

Provider Business Mailing Address
First Line	:	600 LIBERTY LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-9432
Country	:	US
Telephone Number	:	405-548-1029
Fax Number	:	817-549-3172

Provider Business Practice Location Address
First Line	:	600 LIBERTY LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-9432
Country	:	US
Telephone Number	:	405-548-1029
Fax Number	:	817-549-3172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	09/14/2021

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Directions to “ SARA CAROLINE HIBBS ” Practice Location

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