Healthcare Provider Details

I. General information

NPI: 1093923708
Provider Name (Legal Business Name): CARLA KATHLEEN SMITH RPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

1030 N QUEBEC AVE
TULSA OK
74115-6306
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-1471
  • Fax:
Mailing address:
  • Phone: 918-834-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTA820
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: