Healthcare Provider Details

I. General information

NPI: 1619186103
Provider Name (Legal Business Name): SOUTHWEST THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S BROADWAY ST
MARLOW OK
73055-3313
US

IV. Provider business mailing address

1107 N GRAND BLVD
DUNCAN OK
73533-3767
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-2319
  • Fax:
Mailing address:
  • Phone: 580-606-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOA307
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL ALLIE
Title or Position: OWNER
Credential: COTA
Phone: 580-252-3054