Provider Demographics
NPI:1215075528
Name:THERAPY CARE OUTPATIENT PC
Entity type:Organization
Organization Name:THERAPY CARE OUTPATIENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:BUENROSTRO
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPI
Authorized Official - Phone:405-379-8085
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848
Mailing Address - Country:US
Mailing Address - Phone:405-379-8085
Mailing Address - Fax:405-379-8084
Practice Address - Street 1:317 E 8TH STREET
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848
Practice Address - Country:US
Practice Address - Phone:405-379-8085
Practice Address - Fax:405-379-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63225100000X
OK184225X00000X
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748280AMedicaid
OK100748280BMedicaid
OK100748280AMedicaid
OK300522027Medicare ID - Type Unspecified