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NPI Code Detail

MEDICARE: MRS. REGAN JANEAN MCMANUS CTRS

MEDICARE:  MRS. REGAN JANEAN MCMANUS  CTRS
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
1225800000XRecreation Therapist

General Provider Information

NPI Number : 1316168842
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REGAN JANEAN MCMANUS CTRS
Provider Business Mailing Address
First Line : 1142 E MCLEOD AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066
Country : US
Telephone Number : 918-227-5929
Fax Number :
Provider Business Practice Location Address
First Line : 6161 S YALE AVE
Second Line : 4 SOUTH
City : TULSA
State : OK
Zip : 74136
Country : US
Telephone Number : 918-494-4250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. REGAN JANEAN MCMANUS CTRS” Practice Location

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