Provider Demographics
NPI:1366845794
Name:THERAPITAS OKC, LLC
Entity Type:Organization
Organization Name:THERAPITAS OKC, LLC
Other - Org Name:THERAPITAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-624-1237
Mailing Address - Street 1:5350 S WESTERN AVE
Mailing Address - Street 2:SUITE 525
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4520
Mailing Address - Country:US
Mailing Address - Phone:405-355-3239
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4520
Practice Address - Country:US
Practice Address - Phone:405-355-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPITAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty