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General NPI Number Information
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NPI Number | 1174941512
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Entity Type | Organization
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Legal Business Name | GREAT CHANGES RESOURCE CENTER PLLC
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 1024 NW 47TH ST SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-6400
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Country | US
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Telephone | 405-604-0496
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Fax | 405-601-3750
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Provider Business Mailing Address
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Address Line | PO BOX 720997
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City | OKLAHOMA CITY
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State | OK
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Zip | 73172-0997
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Country | US
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Telephone | 405-604-0496
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Fax | 405-601-3750
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURA L SHOUN
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Credential | OTRL
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Telephone | 405-604-0496
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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 | OT223
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License Number State | OK
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