Provider Demographics
NPI:1972097657
Name:IMPACT REHAB CONSULTANTS
Entity Type:Organization
Organization Name:IMPACT REHAB CONSULTANTS
Other - Org Name:IMPACT REHABILITATION AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIEGENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:918-809-8666
Mailing Address - Street 1:813 E 6TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4701
Mailing Address - Country:US
Mailing Address - Phone:918-756-3330
Mailing Address - Fax:
Practice Address - Street 1:813 E 6TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4701
Practice Address - Country:US
Practice Address - Phone:918-756-3330
Practice Address - Fax:918-756-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty