Provider Demographics
NPI:1932858636
Name:EGAN, EMILIE (RBT)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:EGAN
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 1:16362 MUIRFIELD PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9145
Mailing Address - Country:US
Mailing Address - Phone:405-406-4136
Mailing Address - Fax:405-562-5137
Practice Address - Street 1:16362 MUIRFIELD PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9145
Practice Address - Country:US
Practice Address - Phone:405-406-4136
Practice Address - Fax:405-562-5137
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-22-207547106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician