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Organization
THE SHINE PEDIATRIC THERAPY CENTER
Active
Organization
THE SHINE PEDIATRIC THERAPY CENTER
Active
Other names
Shine Pediatric Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN WONDERLY (OWNER)
(405) 708-7172
Entity
Organization
Contact information
Practice address
921 W MISSOURI AVE, CHICKASHA, OK 73018-4328
(405) 612-8396
Mailing address
921 W MISSOURI AVE, CHICKASHA, OK 73018-4328
(405) 612-8396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
NULL
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
04/12/2023
Last updated
04/12/2023
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