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General NPI Number Information
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NPI Number | 1538791884
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Entity Type | Organization
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Legal Business Name | CCR SERVICES LLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 2412 FAIRWAY CT
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City | NORMAN
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State | OK
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Zip | 73069-6335
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Country | US
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Telephone | 405-831-7263
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 FAIRWAY CT
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City | NORMAN
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State | OK
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Zip | 73069-6335
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Country | US
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Telephone | 405-831-7263
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | CASSIE S COOPER-RODKEY
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Credential | OT/L
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Telephone | 405-831-7263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number |
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License Number State |
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