Healthcare Provider Details

I. General information

NPI: 1245158054
Provider Name (Legal Business Name): KELSEY INGRAM OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 TINKER DIAGONAL
DEL CITY OK
73115-1017
US

IV. Provider business mailing address

3001 TINKER DIAGONAL
DEL CITY OK
73115-1017
US

V. Phone/Fax

Practice location:
  • Phone: 405-221-1341
  • Fax:
Mailing address:
  • Phone: 405-221-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6510
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: