Healthcare Provider Details

I. General information

NPI: 1356669626
Provider Name (Legal Business Name): OKECHUKWU OKORIE CM1, BSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S WESTERN AVE SUITE 200
OKLAHOMA CITY OK
73139-1817
US

IV. Provider business mailing address

12726 N MACARTHUR BLVD APT 26B
OKLAHOMA CITY OK
73142
US

V. Phone/Fax

Practice location:
  • Phone: 405-605-5601
  • Fax: 405-605-7914
Mailing address:
  • Phone: 405-201-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: