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General NPI Number Information
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NPI Number | 1740366210
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Entity Type | Organization
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Legal Business Name | REVELATION ENTERPRISES INC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 4521 NW 3RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73127-6401
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Country | US
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Telephone | 405-319-0685
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Fax | 405-319-0684
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Provider Business Mailing Address
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Address Line | 4521 NW 3RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73127-6401
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Country | US
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Telephone | 405-319-0685
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Fax | 405-319-0684
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. ANITA C MULLIN
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Credential | CMF
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Telephone | 405-319-0685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 39
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License Number State | OK
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