Healthcare Provider Details

I. General information

NPI: 1003847252
Provider Name (Legal Business Name): STEPHANIE L KUYKENDALL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S FLORENCE AVE SUITE 150
CLAREMORE OK
74017
US

IV. Provider business mailing address

PO BOX 2206
CLAREMORE OK
74018-2206
US

V. Phone/Fax

Practice location:
  • Phone: 918-645-3060
  • Fax: 918-341-3888
Mailing address:
  • Phone: 918-645-3060
  • Fax: 918-341-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT753
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: