Healthcare Provider Details

I. General information

NPI: 1629013453
Provider Name (Legal Business Name): TULSA ERGONOMIC CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 E 53 ST
TULSA OK
74105-6601
US

IV. Provider business mailing address

2417 E 53 ST
TULSA OK
74105-6601
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-8412
  • Fax: 918-712-8413
Mailing address:
  • Phone: 918-712-8412
  • Fax: 918-712-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3731
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number411
License Number StateOK

VIII. Authorized Official

Name: MRS. NANCY A CYR
Title or Position: OFFICE MGR
Credential:
Phone: 918-712-8412