Organization
FUNCTIONALITY THERAPY SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY R OGDEN M.A. CCC-SLP (OWNER)
(580) 220-7786
Entity
Organization
Contact information
Practice address
10 W MAIN ST STE 218A, ARDMORE, OK 73401-6515
(580) 220-7786
Mailing address
1000 ROCKFORD CT, ARDMORE, OK 73401-3408
(580) 220-7786
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-17-25192
OK
235Z00000X
Speech-Language Pathologist
Primary
3713
OK
Other
Enumeration date
05/15/2017
Last updated
05/15/2017
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