Provider Demographics
NPI:1750310538
Name:THERAFUN LLC
Entity Type:Organization
Organization Name:THERAFUN LLC
Other - Org Name:THERAFUNCTION INC DBA THERAFUN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RISTAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-202-4112
Mailing Address - Street 1:1201 W. BOYD ST.
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4801
Mailing Address - Country:US
Mailing Address - Phone:405-366-7898
Mailing Address - Fax:405-366-0010
Practice Address - Street 1:1201 W. BOYD ST.
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4801
Practice Address - Country:US
Practice Address - Phone:405-366-7898
Practice Address - Fax:405-366-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225XP0200X, 235Z00000X, 225XP0200X, 235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746270AMedicaid