Healthcare Provider Details

I. General information

NPI: 1245545458
Provider Name (Legal Business Name): GORE THERAPY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W GORE BLVD
LAWTON OK
73505-6336
US

IV. Provider business mailing address

4121 W GORE BLVD
LAWTON OK
73505-6336
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-8900
  • Fax: 580-353-8903
Mailing address:
  • Phone: 580-353-8900
  • Fax: 580-353-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1046
License Number StateOK

VIII. Authorized Official

Name: MS. GRETA M. WORTHINGTON
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS/CCC-SLP
Phone: 580-353-8900