Healthcare Provider Details

I. General information

NPI: 1013600741
Provider Name (Legal Business Name): JOSMARIE OQUENDO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 E 88TH ST
INDIANAPOLIS IN
46256-1235
US

IV. Provider business mailing address

827 YORKSHIRE RD
ANDERSON IN
46012-2649
US

V. Phone/Fax

Practice location:
  • Phone: 317-849-5437
  • Fax: 317-842-5911
Mailing address:
  • Phone: 939-422-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB800836
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: