# THE SHINE PEDIATRIC THERAPY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shine Pediatric Therapy Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023704236
- **Authorized official:** JUSTIN WONDERLY (OWNER)
- **Authorized official phone:** (405) 708-7172

## Contact information

- **Practice address:** 921 W MISSOURI AVE, CHICKASHA, OK 73018-4328
- **Practice address phone:** (405) 612-8396
- **Mailing address:** 921 W MISSOURI AVE, CHICKASHA, OK 73018-4328
- **Mailing address phone:** (405) 612-8396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2023
- **Last updated:** 04/12/2023