Healthcare Provider Details

I. General information

NPI: 1316168842
Provider Name (Legal Business Name): REGAN JANEAN MCMANUS CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE 4 SOUTH
TULSA OK
74136
US

IV. Provider business mailing address

1142 E MCLEOD AVE
SAPULPA OK
74066
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-4250
  • Fax:
Mailing address:
  • Phone: 918-227-5929
  • Fax:

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: