The Shine Pediatric Therapy Center
Occupational Therapist in Chickasha, OK. Organization (NPI-2).
NPI number1023704236
StatusActive
Last updated in NPPESApr 12, 2023
Details
- NPI
- 1023704236
- Entity type
- Organization (NPI-2)
- Legal business name
- The Shine Pediatric Therapy Center
- Organization subpart
- No
- Enumeration date
- Apr 12, 2023
- Certification date
- Apr 12, 2023
- Last updated
- Apr 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | – | – | Yes |
Other names
- Shine Pediatric Therapy Center (Doing Business As)
Practice location
921 W Missouri AveChickasha, OK 73018-4328
Phone 405-612-8396
Mailing address
921 W Missouri AveChickasha, OK 73018-4328
Phone 405-612-8396
Authorized official
Justin Wonderly
Owner
4057087172
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