Provider Demographics
NPI:1093589483
Name:DIAZ, SARAH ELIZABETH (RBT-23-301045)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RBT-23-301045
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:FITTSTOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74842-0183
Mailing Address - Country:US
Mailing Address - Phone:580-235-3975
Mailing Address - Fax:
Practice Address - Street 1:930 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6319
Practice Address - Country:US
Practice Address - Phone:405-384-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-301045106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKRBT-23-301045OtherREGISTERED BEHAVIOR TECHNICIAN