Organization
HOME MODS BY THERAPISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERI GILL MCKENZIE RPT (OWNER)
(580) 221-3950
Entity
Organization
Contact information
Practice address
3424 MOUNT WASHINGTON RD, ARDMORE, OK 73401-9311
(580) 221-3950
Mailing address
3424 MOUNT WASHINGTON RD, ARDMORE, OK 73401-9311
(580) 221-3950
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
2242
OK
225XE0001X
Environmental Modification Occupational Therapist
Primary
600
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200006160A
—
OK
Enumeration date
07/21/2014
Last updated
07/21/2014
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