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NPI Code Detail

MEDICARE: MRS. RUBY O'BANNON WALLINGER BCBA

MEDICARE: MRS. RUBY O'BANNON WALLINGER 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
1103K00000XBehavior Analyst1-11-9014FL

General Provider Information

NPI Number : 1245685924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RUBY O'BANNON WALLINGER BCBA
Provider Business Mailing Address
First Line : 4022 SPRUCE VALLEY DR
Second Line :
City : KINGWOOD
State : TX
Zip : 77345-1371
Country : US
Telephone Number : 281-224-6183
Fax Number :
Provider Business Practice Location Address
First Line : 2825 W TOWN CENTER CIR
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3734
Country : US
Telephone Number : 281-570-2420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2016
Last Update Date : 04/29/2016

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