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General NPI Number Information
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NPI Number | 1477746741
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Entity Type | Organization
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Legal Business Name | BROKEN ARROW REHABILITATION SPECIALISTS
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 2950 S ELM PL STE 240
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7871
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Country | US
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Telephone | 918-451-5276
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Fax | 918-451-5123
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Provider Business Mailing Address
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Address Line | 2950 S ELM PL STE 240
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7871
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Country | US
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Telephone | 918-451-5276
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Fax | 918-451-5123
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTINA CLAMMER
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Credential |
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Telephone | 918-451-5276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | OK4055
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | OK19313
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | OK19953
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License Number State | OK
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