Healthcare Provider Details

I. General information

NPI: 1932063070
Provider Name (Legal Business Name): MOTOR MOUTH VINITA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 S WILSON ST
VINITA OK
74301-4245
US

IV. Provider business mailing address

10160 E PORT RD
CATOOSA OK
74015-6134
US

V. Phone/Fax

Practice location:
  • Phone: 918-244-1002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN BRUDER
Title or Position: OWNER
Credential:
Phone: 918-704-2760