Healthcare Provider Details

I. General information

NPI: 1891683058
Provider Name (Legal Business Name): REESE MCKAY ZUMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11982 S MULBERRY CT
JENKS OK
74037-2181
US

IV. Provider business mailing address

14020 N 155TH EAST AVE
COLLINSVILLE OK
74021-5603
US

V. Phone/Fax

Practice location:
  • Phone: 539-777-0904
  • Fax:
Mailing address:
  • Phone: 918-728-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: