1689766859 NPI number — THERAPY & DEVELOPMENTAL RESOURCES OF OKLAHOMA, PLLC

Table of content: (NPI 1689766859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689766859 NPI number — THERAPY & DEVELOPMENTAL RESOURCES OF OKLAHOMA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY & DEVELOPMENTAL RESOURCES OF OKLAHOMA, PLLC
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:
Provider Other Organization Name Type Code:
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:
1689766859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1220
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:
73083-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-919-2026
Provider Business Mailing Address Fax Number:
888-547-5376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 E MAIN ST
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:
73034-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-919-2026
Provider Business Practice Location Address Fax Number:
888-547-5376
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHENER
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
LAWANDA
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
405-919-2026

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT410 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT1436 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200084300A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com