MEDICARE: THE MASSAGE CLINIC OF OKC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1003796293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MASSAGE CLINIC OF OKC LLC

Provider Business Mailing Address
First Line	:	2816 NW 57TH ST STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7042
Country	:	US
Telephone Number	:	405-500-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 NW 57TH ST STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7042
Country	:	US
Telephone Number	:	405-500-8874
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TAYLOR GABRIELLE FERGUSON
Credential	:	LMT
Telephone Number	:	405-861-7987

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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