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General NPI Number Information
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NPI Number | 1336445451
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Entity Type | Organization
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Legal Business Name | CARE PLUS HEALTH PROVIDERS LLC
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 522 W 16TH ST
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City | ADA
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State | OK
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Zip | 74820-7610
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Country | US
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Telephone | 405-761-7740
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Fax | 580-421-9491
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Provider Business Mailing Address
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Address Line | PO BOX 2297
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City | ADA
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State | OK
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Zip | 74821-2297
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Country | US
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Telephone | 405-761-7740
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Fax | 580-421-9491
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Authorized Official
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Title or Position | MEMBER/CHAIRMAN
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Name | KAHLILA FOWLER
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Credential | OTD,OTR/L,CEAS
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Telephone | 405-761-7740
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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 | 1433
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License Number State | OK
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