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General NPI Number Information
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NPI Number | 1700535572
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Entity Type | Individual
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Provider Name | MR. EMMANUEL ADEMOLA OKETUNMBI JR.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 7447 CAMBRIDGE ST APT 47
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City | HOUSTON
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State | TX
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Zip | 77054-2027
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Country | US
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Telephone | 713-859-6709
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Fax |
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Provider Business Mailing Address
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Address Line | 13828 SUTHERLAND SPRING LN
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City | ROSHARON
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State | TX
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Zip | 77583-2149
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Country | US
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Telephone |
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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 | TX
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