Healthcare Provider Details

I. General information

NPI: 1467176230
Provider Name (Legal Business Name): EBONI OGDEN RBT, CPR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24124 CINCO VILLAGE CENTER BLVD STE 200
KATY TX
77494-8389
US

IV. Provider business mailing address

24124 CINCO VILLAGE CENTER BLVD STE 200
KATY TX
77494-8389
US

V. Phone/Fax

Practice location:
  • Phone: 832-263-6634
  • Fax:
Mailing address:
  • Phone: 832-263-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-22-234551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: