Healthcare Provider Details

I. General information

NPI: 1194708677
Provider Name (Legal Business Name): OKLAHOMA REHAB & RESP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 NW 10TH ST
OKLAHOMA CITY OK
73103-3910
US

IV. Provider business mailing address

428 NW 10TH ST
OKLAHOMA CITY OK
73103-3910
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-0533
  • Fax: 405-232-0125
Mailing address:
  • Phone: 405-232-0533
  • Fax: 405-232-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JARICA WILCOX
Title or Position: MANAGER
Credential:
Phone: 405-232-0533