Provider Demographics
NPI:1952876492
Name:KLR INNOVATIONS LLC
Entity type:Organization
Organization Name:KLR INNOVATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RYIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:580-352-1016
Mailing Address - Street 1:410 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1922
Mailing Address - Country:US
Mailing Address - Phone:580-749-4227
Mailing Address - Fax:580-749-4487
Practice Address - Street 1:410 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1922
Practice Address - Country:US
Practice Address - Phone:580-749-4227
Practice Address - Fax:580-749-4487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLR INNOVATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty