Healthcare Provider Details

I. General information

NPI: 1750310538
Provider Name (Legal Business Name): THERAFUN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W. BOYD ST.
NORMAN OK
73069-4801
US

IV. Provider business mailing address

1201 W. BOYD ST.
NORMAN OK
73069-4801
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-7898
  • Fax: 405-366-0010
Mailing address:
  • Phone: 405-366-7898
  • Fax: 405-366-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LANA J RISTAU
Title or Position: CO-OWNER
Credential:
Phone: 405-202-4112