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NPI Code Detail

MEDICARE: ANNETTE OKONOFUA BCBA, M.ED.

MEDICARE: ANNETTE OKONOFUA BCBA, M.ED.
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 Analyst1-21-48340CO
2106S00000XBehavior TechnicianRBT-17-39187TX

General Provider Information

NPI Number : 1336649417
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE OKONOFUA BCBA, M.ED.
Provider Business Mailing Address
First Line : 8104 WESSON RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-3005
Country : US
Telephone Number : 817-812-4422
Fax Number :
Provider Business Practice Location Address
First Line : 1915 AEROTECH DR STE 190
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-4213
Country : US
Telephone Number : 719-301-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2018
Last Update Date : 10/13/2021

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