Provider Demographics
NPI:1487268850
Name:HOMER, CODIE (RBT)
Entity type:Individual
Prefix:
First Name:CODIE
Middle Name:
Last Name:HOMER
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 1:1300 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4427
Mailing Address - Country:US
Mailing Address - Phone:469-531-3043
Mailing Address - Fax:
Practice Address - Street 1:1809 COMMONS CIR STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9528
Practice Address - Country:US
Practice Address - Phone:405-467-4551
Practice Address - Fax:405-324-0971
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-20-133747106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician