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NPI Code Detail

MEDICARE: SAMANTHA JOHNS RBT

MEDICARE: SAMANTHA JOHNS RBT
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 TechnicianRBT-21-159952OK

General Provider Information

NPI Number : 1538744099
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JOHNS RBT
Provider Business Mailing Address
First Line : 2208 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3629
Country : US
Telephone Number : 918-900-6237
Fax Number :
Provider Business Practice Location Address
First Line : 2208 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3629
Country : US
Telephone Number : 918-900-6237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2021
Last Update Date : 01/19/2023

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Directions to “ SAMANTHA JOHNS RBT” Practice Location

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