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Individual

KELLY WHITEHEAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MOT

Contact information

Practice address
6800 NW 39TH EXPY, BETHANY, OK 73008-2513
(405) 789-6711
Mailing address
6800 NW 39TH EXPY, BETHANY, OK 73008-2513
(405) 789-6711

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200499510
OK
Enumeration date
07/23/2013
Last updated
10/19/2015
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