Provider Demographics
NPI:1720376577
Name:SHRUM, ALETHEA FAITH (OT)
Entity Type:Individual
Prefix:
First Name:ALETHEA
Middle Name:FAITH
Last Name:SHRUM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 4TH AVE NW # 296
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7711 E 111TH ST
Practice Address - Street 2:SUITE 127
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2570
Practice Address - Country:US
Practice Address - Phone:580-795-4561
Practice Address - Fax:918-364-4276
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist