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NPI Code Detail

MEDICARE: MADELINE WELLS MA, BCBA

MEDICARE: MADELINE WELLS MA, BCBA
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 Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1144833773
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE WELLS MA, BCBA
Provider Business Mailing Address
First Line : 14521 TRAVERTINE FALLS LN
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-8519
Country : US
Telephone Number : 817-891-2218
Fax Number :
Provider Business Practice Location Address
First Line : 416 W 15TH ST STE 600
Second Line :
City : EDMOND
State : OK
Zip : 73013-3672
Country : US
Telephone Number : 405-389-4530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2020
Last Update Date : 11/12/2024

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