Provider Demographics
NPI:1922355189
Name:EMPOWERING LIFE THERAPY, PLLC
Entity Type:Organization
Organization Name:EMPOWERING LIFE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:405-694-7703
Mailing Address - Street 1:783 COUNTY STREET 2981
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-1109
Mailing Address - Country:US
Mailing Address - Phone:405-694-7703
Mailing Address - Fax:866-721-5328
Practice Address - Street 1:783 COUNTY STREET 2981
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-1109
Practice Address - Country:US
Practice Address - Phone:405-694-7703
Practice Address - Fax:866-721-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1721225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200341030BMedicaid