Individual
JOVAN PRIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
5701 SE 74TH ST STE G, OKLAHOMA CITY, OK 73135-1104
(405) 610-1909
(405) 610-1910
Mailing address
14715 BRISTOL PARK BLVD, EDMOND, OK 73013-1894
(405) 840-1686
(405) 840-1006
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5279
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200802530A
—
OK
Enumeration date
11/02/2018
Last updated
11/14/2018
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