Most Relevant Information
Provider Data
| NPI Number: | 1003384546 |
| Provider Name: | JOVAN PRIDE OT |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 5279 |
Most Important Dates
| Enumeration Date: | 11/02/2018 |
| Last Updated: | 11/14/2018 |
Provider Practice Location
5701 SE 74TH ST STE G
OKLAHOMA CITY
OK
731351104
Practice Location Phone/Fax
| Phone: | 4056101909 |
| Fax: | 4056101910 |
Provider Mailing Location
14715 BRISTOL PARK BLVD
EDMOND
OK
730131894
Provider Mailing Phone/Fax
| Phone: | 4058401686 |
| Fax: | 4058401006 |