Healthcare Provider Details

I. General information

NPI: 1669703690
Provider Name (Legal Business Name): ELEVATE PEDIATRIC THERAPIES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W WILL ROGERS BLVD
CLAREMORE OK
74017-5421
US

IV. Provider business mailing address

1110 W WILL ROGERS BLVD
CLAREMORE OK
74017-5421
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-4343
  • Fax: 918-341-8687
Mailing address:
  • Phone: 918-341-4343
  • Fax: 918-341-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1823
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number68
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2016
License Number StateOK

VIII. Authorized Official

Name: MARIA L RYLEE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 918-341-4343