Healthcare Provider Details

I. General information

NPI: 1508773169
Provider Name (Legal Business Name): HANNABELLA MADDOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOPPE BLVD STE 3
ADA OK
74820-2319
US

IV. Provider business mailing address

19136 COUNTY ROAD 3590
ADA OK
74820-0449
US

V. Phone/Fax

Practice location:
  • Phone: 405-857-8280
  • Fax: 405-857-8489
Mailing address:
  • Phone: 405-857-8280
  • Fax: 405-857-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-2841488
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: