Provider Demographics
NPI:1134534787
Name:ABLE KIDS THERAPY
Entity type:Organization
Organization Name:ABLE KIDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:919-622-6599
Mailing Address - Street 1:5970 E 31ST ST STE F
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5112
Mailing Address - Country:US
Mailing Address - Phone:918-622-6599
Mailing Address - Fax:
Practice Address - Street 1:5970 E 31ST ST STE F
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5112
Practice Address - Country:US
Practice Address - Phone:918-622-6599
Practice Address - Fax:918-622-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK889103G00000X
OK1303225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty