Healthcare Provider Details

I. General information

NPI: 1104071257
Provider Name (Legal Business Name): THERAPEUTIC CARE DIMENSIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 N MACARTHUR BLVD STE 103
OKLAHOMA CITY OK
73162-1800
US

IV. Provider business mailing address

419 W GRAY ST
NORMAN OK
73069-7117
US

V. Phone/Fax

Practice location:
  • Phone: 405-650-7577
  • Fax: 405-470-7428
Mailing address:
  • Phone: 405-809-4200
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0029205
License Number StateOK

VIII. Authorized Official

Name: MARIE HELEN MASON
Title or Position: PRESIDENT
Credential: ARNP
Phone: 405-650-7577