Provider Demographics
NPI:1447737440
Name:MORITZ, EMMA MICHELLE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MICHELLE
Last Name:MORITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 N OWASSO EXPY STE E
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4482
Mailing Address - Country:US
Mailing Address - Phone:918-516-2211
Mailing Address - Fax:
Practice Address - Street 1:8787 N OWASSO EXPY STE E
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4482
Practice Address - Country:US
Practice Address - Phone:918-516-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-257719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician