MEDICARE: KELLY KAEMPER GILLINGHAM OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	967	OK

General Provider Information

NPI Number	:	1841416443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY KAEMPER GILLINGHAM OTR

Provider Business Mailing Address
First Line	:	RR 1 BOX 57
Second Line	:
City	:	BINGER
State	:	OK
Zip	:	73009-9731
Country	:	US
Telephone Number	:	405-643-2577
Fax Number	:	405-643-2577

Provider Business Practice Location Address
First Line	:	801 N WASHINGTON ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-4032
Country	:	US
Telephone Number	:	580-772-3993
Fax Number	:	580-774-1032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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