Provider Demographics
NPI:1912524679
Name:OZAN, MADELEINE (RBT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:OZAN
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 1:1806 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6392
Mailing Address - Country:US
Mailing Address - Phone:405-482-1905
Mailing Address - Fax:405-561-4123
Practice Address - Street 1:146 SW 134TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73170-1488
Practice Address - Country:US
Practice Address - Phone:405-265-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT20125146106S00000X
OK1-24-71303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician