Healthcare Provider Details

I. General information

NPI: 1043635345
Provider Name (Legal Business Name): SWALLOWING AND NEUROLOGICAL REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2014
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S COLUMBIA AVE SUITE 470
TULSA OK
74114-3518
US

IV. Provider business mailing address

2121 S COLUMBIA AVE SUITE 470
TULSA OK
74114-3518
US

V. Phone/Fax

Practice location:
  • Phone: 918-928-4700
  • Fax: 918-928-4701
Mailing address:
  • Phone: 918-928-4700
  • Fax: 918-928-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number4027
License Number StateOK

VIII. Authorized Official

Name: TIFFANY SYBILLE TURNER
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 918-693-8433