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General NPI Number Information
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NPI Number | 1457786154
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Entity Type | Organization
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Legal Business Name | LIFE WITHOUT BOUNDARIES, LLC
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 3401 BILLY CT
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City | EDMOND
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State | OK
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Zip | 73034-9384
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Country | US
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Telephone | 405-203-1779
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Fax | 405-844-0757
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Provider Business Mailing Address
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Address Line | 3401 BILLY CT
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City | EDMOND
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State | OK
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Zip | 73034-9384
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Country | US
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Telephone | 405-203-1779
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Fax | 405-844-0757
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY ANNE PITMAN
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Credential | OTR/L
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Telephone | 405-203-1779
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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 | 965
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License Number State | OK
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