Provider Demographics
NPI:1184029209
Name:PROFESSIONAL REHABILITATION AND OCCUPATIONAL SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL REHABILITATION AND OCCUPATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS CRC LPC
Authorized Official - Phone:405-948-7767
Mailing Address - Street 1:3033 NW 63RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3607
Mailing Address - Country:US
Mailing Address - Phone:405-948-7767
Mailing Address - Fax:
Practice Address - Street 1:3033 NW 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3607
Practice Address - Country:US
Practice Address - Phone:405-948-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK866251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health