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General NPI Number Information
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NPI Number | 1891218202
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Entity Type | Organization
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Legal Business Name | ELITE THERAPY, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 1505 RENAISSANCE BLVD
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City | EDMOND
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State | OK
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Zip | 73013-3018
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Country | US
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Telephone | 405-850-8497
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Fax | 405-300-0643
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Provider Business Mailing Address
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Address Line | 1505 RENAISSANCE BLVD
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City | EDMOND
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State | OK
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Zip | 73013-3018
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Country | US
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Telephone | 405-850-8497
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Fax | 405-300-0643
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SHEA NICOLE PARRY
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Credential | M.ED., M.S. CCC-SLP
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Telephone | 405-850-8497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2927
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License Number State | OK
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