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NPI Code Detail

MEDICARE: HARLEY PAIGE DEMAREE

MEDICARE: HARLEY PAIGE DEMAREE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1790449916
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARLEY PAIGE DEMAREE
Provider Business Mailing Address
First Line : 4515 E 91ST ST STE 201
Second Line :
City : TULSA
State : OK
Zip : 74137-2862
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4515 E 91ST ST STE 201
Second Line :
City : TULSA
State : OK
Zip : 74137-2862
Country : US
Telephone Number : 918-730-9123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2021
Last Update Date : 10/25/2021

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Directions to “ HARLEY PAIGE DEMAREE ” Practice Location

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