Healthcare Provider Details

I. General information

NPI: 1255504635
Provider Name (Legal Business Name): HEATH WELLS M.S., CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E. AIRPORT ROAD
OKMULGEE OK
74447
US

IV. Provider business mailing address

246 IMPERIAL BLVD
SAND SPRINGS OK
74063-7117
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-9211
  • Fax: 918-756-9211
Mailing address:
  • Phone: 918-756-9211
  • Fax: 918-756-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: