Healthcare Provider Details

I. General information

NPI: 1538814520
Provider Name (Legal Business Name): SAINT RITA PEDIATRIC THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8524 S. WESTERN SUITE 113
OKLAHOMA CITY OK
73139
US

IV. Provider business mailing address

8524 S. WESTERN SUITE 113
OKLAHOMA CITY OK
73139
US

V. Phone/Fax

Practice location:
  • Phone: 405-221-8595
  • Fax: 405-931-0022
Mailing address:
  • Phone: 405-221-8595
  • Fax: 405-931-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. AMADOR CARDOZA
Title or Position: CEO
Credential:
Phone: 405-221-8595