MEDICARE: FUNCTIONAL FOUNDATIONS SPEECH THERAPY PLLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1730764374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL FOUNDATIONS SPEECH THERAPY PLLC

Provider Business Mailing Address
First Line	:	2312 W PITTSBURG ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4731
Country	:	US
Telephone Number	:	918-808-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 W PITTSBURG ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4731
Country	:	US
Telephone Number	:	918-808-1380
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE CALIBEY
Credential	:	MS, CCC-SLP
Telephone Number	:	918-808-1380

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/29/2026

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