MEDICARE: BREEZE THERAPY LLC

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	:	1790633865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREEZE THERAPY LLC

Provider Business Mailing Address
First Line	:	510 BERRY LN
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-9015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 BERRY LN
Second Line	:
City	:	CHANDLER
State	:	OK
Zip	:	74834-9015
Country	:	US
Telephone Number	:	405-240-2902
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYDNEY NICOL
Credential	:
Telephone Number	:	405-240-2902

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

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Directions to “BREEZE THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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