Provider Demographics
NPI:1750089975
Name:HARTLEY, CAROLINE ALLEN (RBT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ALLEN
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-6304
Mailing Address - Country:US
Mailing Address - Phone:425-241-8681
Mailing Address - Fax:
Practice Address - Street 1:206 DARLENE DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-1517
Practice Address - Country:US
Practice Address - Phone:425-241-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-23-256935106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician