Healthcare Provider Details

I. General information

NPI: 1356692727
Provider Name (Legal Business Name): SHANNON LEA HELTON BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 23RD ST STE208
OKLAHOMA CITY OK
73103-1469
US

IV. Provider business mailing address

600 NW 23RD ST STE208
OKLAHOMA CITY OK
73103-1469
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-0423
  • Fax: 405-601-9626
Mailing address:
  • Phone: 405-601-0423
  • Fax: 405-601-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number0000
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: