Provider Demographics
NPI:1891218202
Name:ELITE THERAPY, LLC
Entity Type:Organization
Organization Name:ELITE THERAPY, LLC
Other - Org Name:ELITE THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS CCC-SLP
Authorized Official - Phone:405-850-8497
Mailing Address - Street 1:1505 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3018
Mailing Address - Country:US
Mailing Address - Phone:405-850-8497
Mailing Address - Fax:405-300-0643
Practice Address - Street 1:1505 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3018
Practice Address - Country:US
Practice Address - Phone:405-850-8497
Practice Address - Fax:405-300-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 224Z00000X, 225X00000X
OK2927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200006740CMedicaid
OK2004714030AMedicaid
OK12040663OtherSHEA PARRY M.ED., M.S. CCC-SLP
1326194432OtherJOAN WIGGINS OTR
1043580830OtherDIANA DORETY MS CCC-SLP
1366694663OtherSHEA PARRY M.ED., M.S. CCC-SLP
OK100649180AMedicaid