Individual
JORDAN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3223 E 31ST ST, TULSA, OK 74105-2452
(918) 250-9976
Mailing address
7224 S ELWOOD AVE APT 5202, TULSA, OK 74132-2415
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5604
OK
225XP0200X
Pediatric Occupational Therapist
5604
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5604
OCCUPATIONAL THERAPIST LICENSE
OK
Enumeration date
11/01/2021
Last updated
11/01/2021
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