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Organization

INTENTIONAL LIVES THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RENE DAMAN (OWNER)
(405) 590-7127
Entity
Organization

Contact information

Practice address
3700 DERBY RUN DR, EDMOND, OK 73034-2625
(405) 590-7127
Mailing address
3700 DERBY RUN DR, EDMOND, OK 73034-2625

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2251P0200X
Pediatric Physical Therapist

Other

Enumeration date
05/17/2022
Last updated
05/17/2022
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