Healthcare Provider Details

I. General information

NPI: 1831037712
Provider Name (Legal Business Name): BRETT KETNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 GORDON CIR
NORMAN OK
73026-2958
US

IV. Provider business mailing address

8006 GORDON CIR
NORMAN OK
73026-2958
US

V. Phone/Fax

Practice location:
  • Phone: 405-953-2640
  • Fax:
Mailing address:
  • Phone: 405-953-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number199459
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: