Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JOELLA ESCOE COTA/L (OCCUPATIONAL THERAPY)
(918) 851-0737
Entity
Organization
Contact information
Practice address
17110 E 51ST ST, BROKEN ARROW, OK 74012-9279
(918) 851-0737
Mailing address
17110 E 51ST STREET, BROKEN, OK 74012
(918) 851-0737
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
280
OK
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
OA280
OK
320700000X
Physical Disabilities Residential Treatment Facility
Primary
280
OK
Other
Enumeration date
06/16/2014
Last updated
06/16/2014
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