Healthcare Provider Details

I. General information

NPI: 1154243889
Provider Name (Legal Business Name): MOLLY MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 COMMONS CIR
YUKON OK
73099-9505
US

IV. Provider business mailing address

2801 FARM DR
EL RENO OK
73036-9564
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-6782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26549008
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: