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Individual

KACIE MARIE INGRAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CTRS/L

Contact information

Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 664-4658
Mailing address
4625 N INDIANA AVE, OKLAHOMA CITY, OK 73118-2225

Taxonomy

Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
139
OK

Other

Enumeration date
10/08/2020
Last updated
10/08/2020
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