Healthcare Provider Details

I. General information

NPI: 1033032321
Provider Name (Legal Business Name): UPPER ROOM FOOT CARE AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E HIGHWAY 85 A
AFTON OK
74331-5768
US

IV. Provider business mailing address

517 N FOREMAN ST
VINITA OK
74301-1903
US

V. Phone/Fax

Practice location:
  • Phone: 918-219-9692
  • Fax:
Mailing address:
  • Phone: 918-219-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBER WALKER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 918-219-9692