# REVITALIZE THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528791514
- **Authorized official:** MRS. GINA HATFIELD MOT, OTR/L (OWNER)
- **Authorized official phone:** (580) 579-8114

## Contact information

- **Practice address:** 523 N WASHINGTON AVE, DURANT, OK 74701-3403
- **Practice address phone:** (580) 634-2423
- **Mailing address:** 1802 JUANITAS LN, KINGSTON, OK 73439-5477
- **Mailing address phone:** (580) 579-8114

## Taxonomy

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

## Other

- **Enumeration date:** 07/06/2022
- **Last updated:** 07/06/2022