Provider Demographics
NPI: | 1679761076 |
---|---|
Name: | COMMUNICATION REHAB., INC. |
Entity type: | Organization |
Organization Name: | COMMUNICATION REHAB., INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | GAIL |
Authorized Official - Middle Name: | ELLEN |
Authorized Official - Last Name: | COHEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MACCCSLP |
Authorized Official - Phone: | 918-231-5775 |
Mailing Address - Street 1: | 3430 E. 87TH ST. |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74137 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-231-5775 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3430 E 87TH ST |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74137-2627 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-231-5775 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-10-10 |
Last Update Date: | 2007-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 436 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |