Provider Demographics
NPI:1417031147
Name:THERAPYTIME OT, PC
Entity Type:Organization
Organization Name:THERAPYTIME OT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MAROLF
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:918-712-7868
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-712-7868
Mailing Address - Fax:918-749-2901
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-749-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========001OtherBLUE CROSS BLUE SHIELD