Healthcare Provider Details

I. General information

NPI: 1114248341
Provider Name (Legal Business Name): 1ST CHOICE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12120 S 2ND ST
JENKS OK
74037-2857
US

IV. Provider business mailing address

12120 S 2ND ST
JENKS OK
74037-2857
US

V. Phone/Fax

Practice location:
  • Phone: 918-808-9749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3159
License Number StateOK

VIII. Authorized Official

Name: AMY CARLETTI
Title or Position: PRESIDENT
Credential:
Phone: 918-808-9749