MEDICARE: ECLIPSE HEALTHCARE, L.L.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225200000X	Physical Therapy Assistant
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1225433725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLIPSE HEALTHCARE, L.L.C.

Provider Business Mailing Address
First Line	:	1414 S DENVER AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3423
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:	918-712-7813

Provider Business Practice Location Address
First Line	:	1414 S DENVER AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3423
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:	918-712-7813

Authorized Official
Title or Position	:	PT/OWNER
Name	:	RYAN C BARRY
Credential	:	PT
Telephone Number	:	918-712-7805

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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