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General NPI Number Information
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NPI Number | 1073093712
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Entity Type | Organization
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Legal Business Name | PROSPERITY THERAPY SERVICES INC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 41116 E COUNTY ROAD 1240
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City | KEOTA
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State | OK
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Zip | 74941-6451
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Country | US
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Telephone | 918-697-2909
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Fax |
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Provider Business Mailing Address
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Address Line | 41116 E COUNTY ROAD 1240
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City | KEOTA
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State | OK
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Zip | 74941-6451
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Country | US
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Telephone | 918-697-2909
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/PRESIDENT
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Name | AMY FERGUSON
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Credential | MOT, OTR/L
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Telephone | 918-697-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1904
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License Number State | OK
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