Organization
NEURORESOURCES REHABILITATION SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA MARIE TISDELL OTR/L, MPH, ATP (OWNER)
(405) 605-1466
Entity
Organization
Contact information
Practice address
6108 NW 63RD STREET, SUITE B, OKLAHOMA CITY, OK 73132-7553
(405) 605-1466
(405) 605-1467
Mailing address
PO BOX 12036, OKLAHOMA CITY, OK 73157-2036
(405) 605-1466
(405) 605-1467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT646
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100660200A
—
OK
Enumeration date
08/10/2006
Last updated
11/08/2011
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