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
—
—
Other
Enumeration date
04/12/2023
Last updated
04/12/2023
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