Healthcare Provider Details

I. General information

NPI: 1881581346
Provider Name (Legal Business Name): EMILY CHRISTINE BURRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W DETROIT ST
BROKEN ARROW OK
74012-3629
US

IV. Provider business mailing address

6520 VALLEY VIEW RD
EDMOND OK
73034-8563
US

V. Phone/Fax

Practice location:
  • Phone: 918-900-6237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-446278
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: