Healthcare Provider Details

I. General information

NPI: 1457691313
Provider Name (Legal Business Name): SCOTT RAINWATER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 S GARNETT RD
BROKEN ARROW OK
74012-6004
US

IV. Provider business mailing address

2990 N SIOUX AVE
CLAREMORE OK
74017-3700
US

V. Phone/Fax

Practice location:
  • Phone: 918-872-9777
  • Fax: 918-872-9779
Mailing address:
  • Phone: 918-342-2622
  • Fax: 918-342-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: