Healthcare Provider Details

I. General information

NPI: 1780304089
Provider Name (Legal Business Name): HOLISTIC HEALING OPERATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N MAIN ST
WAGONER OK
74467-2848
US

IV. Provider business mailing address

708 N MAIN ST
WAGONER OK
74467-2848
US

V. Phone/Fax

Practice location:
  • Phone: 567-208-0581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: SARAH JOHNSON
Title or Position: FOUNDER
Credential:
Phone: 918-871-0109