Individual
MRS. KELLY MARIE SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12912 E 86TH ST N, OWASSO, OK 74055-8608
(918) 524-3833
Mailing address
19822 S COVEY CT, CLAREMORE, OK 74019-0041
(918) 274-1300
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1353
OK
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
460722482
OK
Other
Enumeration date
02/09/2021
Last updated
05/09/2025
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