Healthcare Provider Details

I. General information

NPI: 1508450719
Provider Name (Legal Business Name): STEPHANIE OGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E SHADOWBEND AVE
FRIENDSWOOD TX
77546-3859
US

IV. Provider business mailing address

12015 COTTAGE ELM CT
HOUSTON TX
77089-6151
US

V. Phone/Fax

Practice location:
  • Phone: 855-782-7822
  • Fax:
Mailing address:
  • Phone: 832-904-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-152992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: