Healthcare Provider Details

I. General information

NPI: 1013868678
Provider Name (Legal Business Name): MAIKAYLA C CHAMBERS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 N BOSTON PL
TULSA OK
74106-2208
US

IV. Provider business mailing address

4208 W MEMPHIS ST
BROKEN ARROW OK
74012-4633
US

V. Phone/Fax

Practice location:
  • Phone: 405-922-0457
  • Fax:
Mailing address:
  • Phone: 405-922-0457
  • 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: