Healthcare Provider Details

I. General information

NPI: 1346053824
Provider Name (Legal Business Name): MARIA AUGUSTA OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 DOBSON ST
NEW AUGUSTA IN
46268-2128
US

IV. Provider business mailing address

2013 PARSONS DR APT A
INDIANAPOLIS IN
46224-4494
US

V. Phone/Fax

Practice location:
  • Phone: 317-654-6806
  • Fax:
Mailing address:
  • Phone: 347-606-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-365978
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: