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General NPI Number Information
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NPI Number | 1932063070
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Entity Type | Organization
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Legal Business Name | MOTOR MOUTH VINITA
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 479 S WILSON ST
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City | VINITA
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State | OK
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Zip | 74301-4245
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Country | US
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Telephone | 918-244-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 10160 E PORT RD
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City | CATOOSA
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State | OK
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Zip | 74015-6134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAITLIN BRUDER
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Credential |
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Telephone | 918-704-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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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