Healthcare Provider Details

I. General information

NPI: 1194639740
Provider Name (Legal Business Name): KYLIE PAIGE BROSHOUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHARLES PAGE BLVD STE C
SAND SPRINGS OK
74063-8508
US

IV. Provider business mailing address

5650 S ZUNIS AVE
TULSA OK
74105-6120
US

V. Phone/Fax

Practice location:
  • Phone: 918-504-8669
  • Fax: 918-512-4773
Mailing address:
  • Phone: 405-824-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: