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NPI Code Detail

MEDICARE: JACQUELINE MCNALLY RBT

MEDICARE: JACQUELINE MCNALLY RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB510774OK

General Provider Information

NPI Number : 1073135463
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE MCNALLY RBT
Provider Business Mailing Address
First Line : 2524 NW 16TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73107-4840
Country : US
Telephone Number : 405-831-4045
Fax Number :
Provider Business Practice Location Address
First Line : 13905 TECHNOLOGY DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-1054
Country : US
Telephone Number : 405-831-4045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2020
Last Update Date : 05/08/2020

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Directions to “ JACQUELINE MCNALLY RBT” Practice Location

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