Individual
MRS. KELLI MICHELLE BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
10229 E 96TH ST N, STE 102, OWASSO, OK 74055-5305
(918) 274-8541
(918) 274-8560
Mailing address
10229 E 96TH ST N, STE 102, OWASSO, OK 74055-5305
(918) 274-8541
(918) 274-8560
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006002907
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36557012
BCBS KC
MO
05
—
578907909
—
MO
Enumeration date
08/05/2006
Last updated
05/19/2016
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