Individual
KENNA JOAN AULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR
Contact information
Practice address
63095 E 293 RD, GROVE, OK 74344-6013
(918) 787-6564
Mailing address
63095 E 293 RD, GROVE, OK 74344-6013
(918) 787-6564
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
00375
MO
225X00000X
Occupational Therapist
17-0119
KS
225X00000X
Occupational Therapist
857
OK
Other
Enumeration date
01/22/2007
Last updated
06/09/2008
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