Healthcare Provider Details

I. General information

NPI: 1578114591
Provider Name (Legal Business Name): OK PEDS PEDIATRIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 S HARRAH RD
NEWALLA OK
74857-7912
US

IV. Provider business mailing address

7301 S HARRAH RD
NEWALLA OK
74857-7912
US

V. Phone/Fax

Practice location:
  • Phone: 405-659-6390
  • Fax: 855-933-0242
Mailing address:
  • Phone: 405-659-6390
  • Fax: 855-933-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SEIRRA LEWELLING
Title or Position: OWNER/SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP/L
Phone: 405-659-6390