Organization
POWER SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE PATRICK (EXECUTIVE DIRECTOR)
(580) 252-4516
Entity
Organization
Contact information
Practice address
2103 W BEECH AVE, DUNCAN, OK 73533-2334
(580) 252-4516
(580) 252-6903
Mailing address
2103 W BEECH AVE, DUNCAN, OK 73533-2334
(580) 252-4516
(580) 252-6903
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
103TC1900X
OK
Other
Enumeration date
09/06/2006
Last updated
08/22/2020
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