Healthcare Provider Details

I. General information

NPI: 1841012887
Provider Name (Legal Business Name): EASTER SEALS OKLAHOMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SHEFFIELD RD
OKLAHOMA CITY OK
73120-1147
US

IV. Provider business mailing address

633 3RD AVE FL 6
NEW YORK NY
10017-6733
US

V. Phone/Fax

Practice location:
  • Phone: 972-394-8900
  • Fax:
Mailing address:
  • Phone: 817-542-1988
  • Fax: 817-303-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROL KHOURY
Title or Position: CFO
Credential:
Phone: 212-727-4270