Healthcare Provider Details

I. General information

NPI: 1619816824
Provider Name (Legal Business Name): DAPHNE ARIANNA RAGUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 S ELM PL
BROKEN ARROW OK
74011-4857
US

IV. Provider business mailing address

308 N ASPEN AVE
BROKEN ARROW OK
74012-2205
US

V. Phone/Fax

Practice location:
  • Phone: 843-298-7308
  • Fax:
Mailing address:
  • Phone: 539-777-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: