Healthcare Provider Details

I. General information

NPI: 1235477274
Provider Name (Legal Business Name): CONNECT HEALTH PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 SPRINGER DR
NORMAN OK
73069-3955
US

IV. Provider business mailing address

2411 SPRINGER DR
NORMAN OK
73069-3955
US

V. Phone/Fax

Practice location:
  • Phone: 405-615-2545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK MICHAEL
Title or Position: DIRECTOR OF REHABILITATION
Credential: P.T., COS-C
Phone: 405-615-2545