Provider Demographics
NPI:1497178156
Name:COMPLETE REHAB, LLC
Entity Type:Organization
Organization Name:COMPLETE REHAB, LLC
Other - Org Name:OKLAHOMA PEDIATRIC THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MILLER HOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-324-0961
Mailing Address - Street 1:1824 COMMONS CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9527
Mailing Address - Country:US
Mailing Address - Phone:405-467-6782
Mailing Address - Fax:405-467-6100
Practice Address - Street 1:1824 COMMONS CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9527
Practice Address - Country:US
Practice Address - Phone:405-324-0961
Practice Address - Fax:405-324-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103K00000X, 103T00000X, 225100000X, 225XP0200X, 235Z00000X, 261QH0700X, 261QR0400X
OK2776225100000X
OK3751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200527550AMedicaid