Healthcare Provider Details

I. General information

NPI: 1437033131
Provider Name (Legal Business Name): CARISSA BURROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA MANESS

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SILVER XING
OKLAHOMA CITY OK
73132-3373
US

IV. Provider business mailing address

9120 NW 127TH STREET
YUKON OK
73099
US

V. Phone/Fax

Practice location:
  • Phone: 405-550-3610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: