Healthcare Provider Details

I. General information

NPI: 1114420700
Provider Name (Legal Business Name): MYCARE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 NW 144TH ST
EDMOND OK
73013-1573
US

IV. Provider business mailing address

1532 NW 144TH ST
EDMOND OK
73013-1573
US

V. Phone/Fax

Practice location:
  • Phone: 405-655-8949
  • Fax: 405-896-9472
Mailing address:
  • Phone: 405-655-8949
  • Fax: 405-896-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREN PESTINGER
Title or Position: OWNER
Credential:
Phone: 405-476-1745