Provider Demographics
NPI:1548370711
Name:KELLY B. TODD CEREBRAL PALSY & NEUROMUSCULAR FOUNDATION, INC
Entity type:Organization
Organization Name:KELLY B. TODD CEREBRAL PALSY & NEUROMUSCULAR FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-683-4621
Mailing Address - Street 1:PO BOX 2643
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74402-2643
Mailing Address - Country:US
Mailing Address - Phone:918-683-4621
Mailing Address - Fax:918-683-4002
Practice Address - Street 1:1111 N 36TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1809
Practice Address - Country:US
Practice Address - Phone:918-683-4621
Practice Address - Fax:918-683-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100724240AMedicaid