Healthcare Provider Details

I. General information

NPI: 1750684270
Provider Name (Legal Business Name): EARLY LEARNING INNOVATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S. GIBSON
WEBBERS FALLS OK
74470
US

IV. Provider business mailing address

PO BOX 62
WARNER OK
74469-0062
US

V. Phone/Fax

Practice location:
  • Phone: 918-441-3468
  • Fax:
Mailing address:
  • Phone: 918-441-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: PROF. JANICE SATORI JOBEY
Title or Position: SR. EARLY LEARNING SPECIALIST
Credential: PH.D (ABD);M.S.,CCPS
Phone: 918-441-3468