Healthcare Provider Details

I. General information

NPI: 1578378733
Provider Name (Legal Business Name): KRISTEN FRAZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 N TULSA AVE
OKLAHOMA CITY OK
73112-1340
US

IV. Provider business mailing address

705 26TH AVE NW
NORMAN OK
73069-6367
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4550
  • Fax:
Mailing address:
  • Phone: 405-308-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2365
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: