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General NPI Number Information
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NPI Number | 1669703690
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Entity Type | Organization
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Legal Business Name | ELEVATE PEDIATRIC THERAPIES PC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 1071 W. BLUE STARR DRIVE
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City | CLAREMORE
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State | OK
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Zip | 74017-5567
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Country | US
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Telephone | 918-342-3800
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Fax | 918-342-3900
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Provider Business Mailing Address
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Address Line | 1071 W BLUE STARR DR STE 101
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City | CLAREMORE
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State | OK
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Zip | 74017-2868
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Country | US
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Telephone | 918-341-4343
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Fax | 918-341-8687
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MARIA L RYLEE
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Credential |
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Telephone | 918-341-4343
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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 | 68
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2016
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1823
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License Number State | OK
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