Healthcare Provider Details

I. General information

NPI: 1982977161
Provider Name (Legal Business Name): MARIA LISA ROETTGER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 10TH ST
OKLAHOMA CITY OK
73106-7220
US

IV. Provider business mailing address

804 LONGMEADOW CT
EDMOND OK
73003-3062
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-4673
  • Fax: 405-528-4674
Mailing address:
  • Phone: 405-818-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: