Provider Demographics
NPI:1063567147
Name:CREATIVE SPEECH THERAPY
Entity type:Organization
Organization Name:CREATIVE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-3530
Mailing Address - Street 1:PO BOX 471674
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-1674
Mailing Address - Country:US
Mailing Address - Phone:918-734-7115
Mailing Address - Fax:
Practice Address - Street 1:2615 E 138TH ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3878
Practice Address - Country:US
Practice Address - Phone:918-734-7115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK697658OtherUNITED HEALTHCARE
OK005308803873OtherBCBSOK
OK7392760OtherAETNA
OK100677120AMedicaid