Provider Demographics
NPI:1699242537
Name:EPIPHANY BIRTH SERVICES, LLC
Entity type:Organization
Organization Name:EPIPHANY BIRTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:MARILYN
Authorized Official - Last Name:ANTOINE-MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CLC, DOULA
Authorized Official - Phone:405-473-5745
Mailing Address - Street 1:8416 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1108
Mailing Address - Country:US
Mailing Address - Phone:405-473-5745
Mailing Address - Fax:
Practice Address - Street 1:1745 NW 16TH ST STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-2078
Practice Address - Country:US
Practice Address - Phone:405-473-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty