Healthcare Provider Details

I. General information

NPI: 1639179336
Provider Name (Legal Business Name): KARRIE HAYES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 S HARVARD AVE SUITE 117
TULSA OK
74135-2631
US

IV. Provider business mailing address

4157 S HARVARD AVE SUITE 117
TULSA OK
74135-2631
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-7868
  • Fax: 918-749-2901
Mailing address:
  • Phone: 918-712-7868
  • Fax: 918-749-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT345
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: