MEDICARE: CERYS E OWEN BCBA, COBA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	1-22-59323	OH

General Provider Information

NPI Number	:	1548777360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CERYS E OWEN BCBA, COBA

Provider Business Mailing Address
First Line	:	130 E WILSON BRIDGE RD STE 200
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2391
Country	:	US
Telephone Number	:	614-615-5145
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E WILSON BRIDGE RD STE 200
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2391
Country	:	US
Telephone Number	:	301-910-3408
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	11/03/2023

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