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General NPI Number Information
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NPI Number | 1255053906
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Entity Type | Organization
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Legal Business Name | PIVOTAL PATHWAYS LLC
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 19021 E CHOKEBERRY ST
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City | OWASSO
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State | OK
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Zip | 74055-0037
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Country | US
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Telephone | 918-972-1088
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Fax | 918-921-8143
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Provider Business Mailing Address
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Address Line | PO BOX 754
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City | OWASSO
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State | OK
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Zip | 74055-0754
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Country | US
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Telephone | 918-972-1088
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Fax | 918-921-8143
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN M GARY
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Credential | RN, BCBA, LBA
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Telephone | 918-972-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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