MEDICARE: PROFESSIONAL REHABILITATION AND OCCUPATIONAL SERVICES

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	251S00000X	Community/Behavioral Health Agency	866	OK

General Provider Information

NPI Number	:	1184029209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL REHABILITATION AND OCCUPATIONAL SERVICES

Provider Business Mailing Address
First Line	:	3033 NW 63RD ST STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3607
Country	:	US
Telephone Number	:	405-948-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 NW 63RD ST STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3607
Country	:	US
Telephone Number	:	405-948-7767
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHY BOTTROFF
Credential	:	MS CRC LPC
Telephone Number	:	405-948-7767

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	10/31/2014

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