Healthcare Provider Details

I. General information

NPI: 1346168093
Provider Name (Legal Business Name): JESSICA BLISS KIEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA NICHOLE BLISS

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 N SHERIDAN RD
TULSA OK
74115-4610
US

IV. Provider business mailing address

523 E 6TH ST
OKMULGEE OK
74447-5520
US

V. Phone/Fax

Practice location:
  • Phone: 918-836-5406
  • Fax:
Mailing address:
  • Phone: 918-756-6060
  • Fax: 918-756-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3039
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: