=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972472090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA CAUDILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17962 E 454 RD
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74346-3643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-837-2062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17962 E 454 RD OFC
-----------------------------------------------------
City | JAY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74346-3643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-557-4496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------