1891218202 NPI number — ELITE THERAPY, LLC

Table of content: (NPI 1891218202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891218202 NPI number — ELITE THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELITE THERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891218202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 RENAISSANCE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-3018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-850-8497
Provider Business Mailing Address Fax Number:
405-300-0643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 RENAISSANCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-850-8497
Provider Business Practice Location Address Fax Number:
405-300-0643
Provider Enumeration Date:
07/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PARRY
Authorized Official First Name:
SHEA
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
405-850-8497

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2927 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200006740C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004714030A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12040663 . This is a "SHEA PARRY M.ED., M.S. CCC-SLP" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1326194432 . This is a "JOAN WIGGINS OTR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043580830 . This is a "DIANA DORETY MS CCC-SLP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1366694663 . This is a "SHEA PARRY M.ED., M.S. CCC-SLP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100649180A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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