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General NPI Number Information
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NPI Number | 1669053807
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Entity Type | Individual
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Provider Name | BLAKE REIMBOLD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 11982 S MULBERRY CT
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City | JENKS
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State | OK
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Zip | 74037-2181
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Country | US
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Telephone | 539-777-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 E 54TH ST
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City | TULSA
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State | OK
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Zip | 74105-6802
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Country | US
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Telephone | 918-978-2049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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