MEDICARE: CHAMPION THERAPY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1194271577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION THERAPY SERVICES

Provider Business Mailing Address
First Line	:	603 N C AVE
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-2211
Country	:	US
Telephone Number	:	918-358-8040
Fax Number	:	918-358-8045

Provider Business Practice Location Address
First Line	:	603 N C AVE
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-2211
Country	:	US
Telephone Number	:	918-358-8040
Fax Number	:	918-358-8045

Authorized Official
Title or Position	:	OWNER
Name	:	RAYMOND LEACH
Credential	:
Telephone Number	:	918-358-8040

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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Directions to “CHAMPION THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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