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General NPI Number Information
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NPI Number | 1952876492
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Entity Type | Organization
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Legal Business Name | KLR INNOVATIONS LLC
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 410 FAIRVIEW AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-1922
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Country | US
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Telephone | 580-749-4227
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Fax | 580-749-4487
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Provider Business Mailing Address
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Address Line | 410 FAIRVIEW AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-1922
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Country | US
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Telephone | 580-749-4227
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Fax | 580-749-4487
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RYIAN L CRENSHAW
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Credential | HIS
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Telephone | 580-352-1016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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