Organization
EAGLES NEST PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L FITZPATRICK OTR/L (OWNER)
(405) 623-9178
Entity
Organization
Contact information
Practice address
14700 SHARON SPRINGS DR, JONES, OK 73049-8700
(405) 623-9178
Mailing address
14700 SHARON SPRINGS DR, JONES, OK 73049-8700
(405) 623-9178
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538279229
INDIVIDUAL NPI
OK
01
—
1593
OKLAHOMA MEDICAL LICENSURE BOARD
OK
Enumeration date
04/26/2022
Last updated
07/08/2022
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