Provider Demographics
NPI:1114420700
Name:MYCARE THERAPY LLC
Entity Type:Organization
Organization Name:MYCARE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PESTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-476-1745
Mailing Address - Street 1:15604 TRADITIONS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1150
Mailing Address - Country:US
Mailing Address - Phone:405-476-1745
Mailing Address - Fax:405-896-9472
Practice Address - Street 1:15604 TRADITIONS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1150
Practice Address - Country:US
Practice Address - Phone:405-476-1745
Practice Address - Fax:405-896-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1546224Z00000X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty