Provider Demographics
NPI:1447827183
Name:HOMETOWN THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:HOMETOWN THERAPY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:PARKHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:580-448-2626
Mailing Address - Street 1:39 ABI LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5067
Mailing Address - Country:US
Mailing Address - Phone:580-339-0995
Mailing Address - Fax:
Practice Address - Street 1:2015 BROADWAY
Practice Address - Street 2:UNIT 2C
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7340
Practice Address - Country:US
Practice Address - Phone:580-339-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200909830Medicaid