Provider Demographics
NPI:1861666885
Name:FUN-CTIONAL THERAPY, INC.
Entity Type:Organization
Organization Name:FUN-CTIONAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:918-809-4392
Mailing Address - Street 1:2305 W WACO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1510
Mailing Address - Country:US
Mailing Address - Phone:918-809-4392
Mailing Address - Fax:
Practice Address - Street 1:2305 W WACO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1510
Practice Address - Country:US
Practice Address - Phone:918-809-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100675330AMedicaid
OK100675330BMedicare PIN
OK200064760AMedicare PIN
OK100675330DMedicare PIN