MEDICARE: RIELLY SCOTT

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	25-457396	OK

General Provider Information

NPI Number	:	1154206654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIELLY SCOTT

Provider Business Mailing Address
First Line	:	1717 S AIR DEPOT BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-5103
Country	:	US
Telephone Number	:	405-831-3130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 S AIR DEPOT BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-5103
Country	:	US
Telephone Number	:	405-831-3130
Fax Number	:

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

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	08/06/2025

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Directions to “ RIELLY SCOTT ” Practice Location

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