Healthcare Provider Details

I. General information

NPI: 1235841016
Provider Name (Legal Business Name): MADISON CAUTHAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 15TH ST STE 800B
EDMOND OK
73013-6682
US

IV. Provider business mailing address

1900 E 15TH ST STE 800B
EDMOND OK
73013-6682
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-6868
  • Fax: 405-562-3444
Mailing address:
  • Phone: 405-455-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-250406
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: