Healthcare Provider Details

I. General information

NPI: 1841942364
Provider Name (Legal Business Name): HEADWAY OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9527 S 87TH EAST AVE
TULSA OK
74133-6410
US

IV. Provider business mailing address

9527 S 87TH EAST AVE
TULSA OK
74133-6410
US

V. Phone/Fax

Practice location:
  • Phone: 832-409-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN SHIRK
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 832-409-3832