Provider Demographics
NPI:1205161064
Name:TITSWORTH, JEREMIAH RAY (MT-BC, LPMT)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:RAY
Last Name:TITSWORTH
Suffix:
Gender:
Credentials:MT-BC, LPMT
Other - Prefix:
Other - First Name:JEREMIAH
Other - Middle Name:RAY
Other - Last Name:STEVENSON-TITSWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC, LPMT
Mailing Address - Street 1:4121 S VAN BUREN ST APT 804
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-8561
Mailing Address - Country:US
Mailing Address - Phone:405-605-9464
Mailing Address - Fax:
Practice Address - Street 1:2912 LAKESIDE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-605-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist