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General NPI Number Information
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NPI Number | 1851869317
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Entity Type | Individual
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Provider Name | JAIME A PINE MED BCBA LBA-OK
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Gender | Female
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1960 HARPER ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8095
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Country | US
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Telephone | 405-281-1040
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Fax | 405-585-2983
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Provider Business Mailing Address
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Address Line | 3903 N HARRISON ST
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City | SHAWNEE
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State | OK
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Zip | 74804-1426
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Country | US
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Telephone | 405-585-2971
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Fax | 405-585-2983
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-34407
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License Number State | OK
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