Organization
ROOSEVELT PREMIER THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SELICA GRANDERSON (DIRECTOR)
(601) 331-4463
Entity
Organization
Contact information
Practice address
1120 N EASTERN AVE STE 108, MOORE, OK 73160-5856
(405) 735-7162
Mailing address
PO BOX 325, HUTTO, TX 78634-0325
(601) 331-4463
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
221700000X
Art Therapist
—
—
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225800000X
Recreation Therapist
—
—
225A00000X
Music Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/12/2024
Last updated
07/15/2024
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