Healthcare Provider Details

I. General information

NPI: 1386151348
Provider Name (Legal Business Name): JESSICA OBREGON RBT-17-38811
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24865 DETROIT RD
WESTLAKE OH
44145-2512
US

IV. Provider business mailing address

4760 BURGER RD
SOUTH EUCLID OH
44121-3831
US

V. Phone/Fax

Practice location:
  • Phone: 440-641-1170
  • Fax:
Mailing address:
  • Phone: 419-307-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38811
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: