Healthcare Provider Details

I. General information

NPI: 1811225378
Provider Name (Legal Business Name): TAMI KIEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2009
Last Update Date: 11/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S CHERRY ST
SKIATOOK OK
74070-1325
US

IV. Provider business mailing address

14145 S 220TH EAST AVE
COWETA OK
74429-6269
US

V. Phone/Fax

Practice location:
  • Phone: 918-396-2149
  • Fax:
Mailing address:
  • Phone: 918-808-8219
  • Fax: 918-486-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1213
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: