Provider Demographics
NPI:1255504635
Name:WELLS, HEATH (MS, CTRS)
Entity Type:Individual
Prefix:MR
First Name:HEATH
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:MS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7117
Mailing Address - Country:US
Mailing Address - Phone:918-756-9211
Mailing Address - Fax:918-756-2078
Practice Address - Street 1:900 E. AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-756-9211
Practice Address - Fax:918-756-9211
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist