Individual
MYKENA MATHESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
RBT-19-102208
OK
225X00000X
Occupational Therapist
Primary
5827
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114068822
—
OK
Enumeration date
02/24/2020
Last updated
12/05/2024
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