Healthcare Provider Details

I. General information

NPI: 1023940483
Provider Name (Legal Business Name): TERRY J RAIRDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 S GRANITE AVE
TULSA OK
74136-7039
US

IV. Provider business mailing address

6800 S GRANITE AVE
TULSA OK
74136-7039
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-5131
  • Fax:
Mailing address:
  • Phone: 918-619-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1133
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: