Provider Demographics
NPI:1083397848
Name:FOUNDATIONS THERAPY, PLLC
Entity Type:Organization
Organization Name:FOUNDATIONS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IDELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-585-2971
Mailing Address - Street 1:3903 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1426
Mailing Address - Country:US
Mailing Address - Phone:405-585-2971
Mailing Address - Fax:405-585-2983
Practice Address - Street 1:1515 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864
Practice Address - Country:US
Practice Address - Phone:405-566-3291
Practice Address - Fax:405-566-3290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATIONS THERAPY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200860730CMedicaid