Provider Demographics
NPI:1538791884
Name:CCR SERVICES LLC
Entity type:Organization
Organization Name:CCR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOPER-RODKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:405-831-7263
Mailing Address - Street 1:2412 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6335
Mailing Address - Country:US
Mailing Address - Phone:405-831-7263
Mailing Address - Fax:
Practice Address - Street 1:2412 FAIRWAY CT
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6335
Practice Address - Country:US
Practice Address - Phone:405-831-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty