Healthcare Provider Details

I. General information

NPI: 1780291740
Provider Name (Legal Business Name): A'JYANA RODGERS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 24TH AVE NW STE 110
NORMAN OK
73069-6556
US

IV. Provider business mailing address

3117 RIDGECREST CT APT 533
NORMAN OK
73072-7565
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-5306
  • Fax:
Mailing address:
  • Phone: 817-933-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-136963
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: