Healthcare Provider Details

I. General information

NPI: 1639439870
Provider Name (Legal Business Name): ITHERAPY, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 S IRVINGTON AVE
TULSA OK
74114-3821
US

IV. Provider business mailing address

2429 S IRVINGTON AVE
TULSA OK
74114-3821
US

V. Phone/Fax

Practice location:
  • Phone: 918-808-9749
  • Fax: 918-794-5216
Mailing address:
  • Phone:
  • Fax: 918-794-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1731
License Number StateOK

VIII. Authorized Official

Name: ALETHEA SHRUM
Title or Position: OWNER
Credential: MS, OTR/L
Phone: 918-810-3067