Healthcare Provider Details

I. General information

NPI: 1699242537
Provider Name (Legal Business Name): EPIPHANY BIRTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 NW 16TH ST STE A
OKLAHOMA CITY OK
73106-2078
US

IV. Provider business mailing address

8416 NW 91ST ST
OKLAHOMA CITY OK
73132-1108
US

V. Phone/Fax

Practice location:
  • Phone: 405-473-5745
  • Fax:
Mailing address:
  • Phone: 405-473-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FARAH MARILYN ANTOINE-MAYBERRY
Title or Position: OWNER
Credential: OT, CLC, DOULA
Phone: 405-473-5745