=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104071257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC CARE DIMENSIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2008
-----------------------------------------------------
Last Update Date | 11/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12101 N MACARTHUR BLVD STE 103
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73162-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-650-7577
-----------------------------------------------------
Fax | 405-470-7428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 W GRAY ST
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-7117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-809-4200
-----------------------------------------------------
Fax | 405-364-5379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIE HELEN MASON
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 405-650-7577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R0029205
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------