Provider Demographics
NPI:1174941512
Name:GREAT CHANGES RESOURCE CENTER PLLC
Entity type:Organization
Organization Name:GREAT CHANGES RESOURCE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:405-604-0496
Mailing Address - Street 1:PO BOX 720997
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0997
Mailing Address - Country:US
Mailing Address - Phone:405-604-0496
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:1024 NW 47TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6400
Practice Address - Country:US
Practice Address - Phone:405-604-0496
Practice Address - Fax:405-601-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT223225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty