Healthcare Provider Details

I. General information

NPI: 1144486317
Provider Name (Legal Business Name): THERAPY 4 KIDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 S YALE AVE STE 103
TULSA OK
74135-7401
US

IV. Provider business mailing address

5110 S YALE AVE STE 103
TULSA OK
74135-7401
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2386
  • Fax: 918-645-8686
Mailing address:
  • Phone: 918-492-2386
  • Fax: 918-645-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1464
License Number StateOK

VIII. Authorized Official

Name: KELLY B GODFREY
Title or Position: PRESIDENT/CEO
Credential: OTR/L
Phone: 918-806-1492