Organization
IMAGINE PEDIATRIC THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA A SANG OTR/L (MANAGER)
(918) 269-4128
Entity
Organization
Contact information
Practice address
12899 E 76TH ST N UNIT NO117, OWASSO, OK 74055-4026
(918) 609-6003
(918) 609-6002
Mailing address
9930 E 510 RD, CLAREMORE, OK 74019-5103
(918) 269-4128
(918) 343-7491
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
944
OK
Other
Enumeration date
07/13/2007
Last updated
04/20/2008
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