Healthcare Provider Details

I. General information

NPI: 1932605508
Provider Name (Legal Business Name): OREGON INSTITUTE OF TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 WASHBURN WAY
KLAMATH FALLS OR
97603
US

IV. Provider business mailing address

3201 CAMPUS DR
KLAMATH FALLS OR
97601-8801
US

V. Phone/Fax

Practice location:
  • Phone: 850-933-4742
  • Fax:
Mailing address:
  • Phone: 541-885-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-05-2497
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number1-05-2497
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1-05-2497
License Number State

VIII. Authorized Official

Name: DR. DAWN ALLISON BAILEY
Title or Position: ASSOC PROF/CLINICAL DIRECTOR
Credential: BCBA-D, LBA
Phone: 541-885-1673