Provider Demographics
NPI:1427227404
Name:EDUCATIONAL THERAPY CENTER
Entity Type:Organization
Organization Name:EDUCATIONAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC
Authorized Official - Phone:918-455-3859
Mailing Address - Street 1:708 W FREEPORT ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2405
Mailing Address - Country:US
Mailing Address - Phone:918-455-3859
Mailing Address - Fax:918-455-3860
Practice Address - Street 1:708 W FREEPORT ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2405
Practice Address - Country:US
Practice Address - Phone:918-455-3859
Practice Address - Fax:918-455-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty