Healthcare Provider Details

I. General information

NPI: 1871922021
Provider Name (Legal Business Name): VIOLET OBONYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 NW 155TH ST
EDMOND OK
73013-8809
US

IV. Provider business mailing address

2817 NW 155TH ST
EDMOND OK
73013-8809
US

V. Phone/Fax

Practice location:
  • Phone: 419-806-3306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: