Healthcare Provider Details

I. General information

NPI: 1619831450
Provider Name (Legal Business Name): OLAITAN REBECCA OPALADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 REVERE DR
PRINCETON TX
75407-6665
US

IV. Provider business mailing address

2116 REVERE DR
PRINCETON TX
75407-6665
US

V. Phone/Fax

Practice location:
  • Phone: 445-209-1890
  • Fax:
Mailing address:
  • Phone: 903-505-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-499052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: