Healthcare Provider Details

I. General information

NPI: 1770166779
Provider Name (Legal Business Name): OK-THERAPLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 KINGSTON BLVD
EDMOND OK
73034-3227
US

IV. Provider business mailing address

1205 KINGSTON BLVD
EDMOND OK
73034-3227
US

V. Phone/Fax

Practice location:
  • Phone: 580-318-9415
  • Fax: 405-999-4998
Mailing address:
  • Phone: 580-318-9415
  • Fax: 405-999-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KORTNEI DIANE GUTIERREZ
Title or Position: OWNER
Credential: COTA
Phone: 580-318-9415