Healthcare Provider Details

I. General information

NPI: 1568544062
Provider Name (Legal Business Name): ADVANCED OCCUPATIONAL REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 SW 59TH ST
OKLAHOMA CITY OK
73119-7033
US

IV. Provider business mailing address

2149 SW 59TH ST
OKLAHOMA CITY OK
73119-7033
US

V. Phone/Fax

Practice location:
  • Phone: 405-370-0546
  • Fax:
Mailing address:
  • Phone: 405-370-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FARIDEH HEIDARPOUR
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-370-0546