Provider Demographics
NPI:1457786154
Name:LIFE WITHOUT BOUNDARIES, LLC
Entity Type:Organization
Organization Name:LIFE WITHOUT BOUNDARIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:405-203-1779
Mailing Address - Street 1:3401 BILLY CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9384
Mailing Address - Country:US
Mailing Address - Phone:405-203-1779
Mailing Address - Fax:405-844-0757
Practice Address - Street 1:3401 BILLY CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9384
Practice Address - Country:US
Practice Address - Phone:405-203-1779
Practice Address - Fax:405-844-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty