=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104415819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HANDS REHAB AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2021
-----------------------------------------------------
Last Update Date | 01/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6905 W WILSHIRE BLVD STE B
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73132-5494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-445-1295
-----------------------------------------------------
Fax | 405-594-6055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6905 W WILSHIRE BLVD STE B
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73132-5494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-445-1295
-----------------------------------------------------
Fax | 405-594-6055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MRS. GRACY G ISAAC
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 405-445-1295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------