MEDICARE: OKISHA DENNA REUBEN

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		NC

General Provider Information

NPI Number	:	1780515239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKISHA DENNA REUBEN

Provider Business Mailing Address
First Line	:	3413 CHRISTAKAIT PL APT D
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-4409
Country	:	US
Telephone Number	:	910-813-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 CHRISTAKAIT PL APT D
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-4409
Country	:	US
Telephone Number	:	910-813-0607
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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