MEDICARE: GEORGIA K LOEW 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
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-22-233577	OTHER	OK	BACB

General Provider Information

NPI Number	:	1124740543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA K LOEW RBT

Provider Business Mailing Address
First Line	:	1900 E 15TH ST STE 800B
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6682
Country	:	US
Telephone Number	:	405-455-6868
Fax Number	:	405-562-3444

Provider Business Practice Location Address
First Line	:	4127 NW 122ND ST STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8880
Country	:	US
Telephone Number	:	405-455-6868
Fax Number	:	405-562-3444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	02/04/2026

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Directions to “ GEORGIA K LOEW RBT” Practice Location

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