Healthcare Provider Details

I. General information

NPI: 1346094950
Provider Name (Legal Business Name): MUSKOGEE THERAPY SPOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N YORK ST
MUSKOGEE OK
74403-4840
US

IV. Provider business mailing address

304 CREEK AVE
FORT GIBSON OK
74434-8992
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-7855
  • Fax:
Mailing address:
  • Phone: 918-577-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MORGAN SALYER
Title or Position: CO-OWNERS
Credential: OTR/L
Phone: 918-557-7855