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General NPI Number Information
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NPI Number | 1104030113
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Entity Type | Individual
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Provider Name | MARY KATHLEEN STALEY P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 744 W 9TH ST REHAB MEDICINE DEPT (H205)
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City | TULSA
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State | OK
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Zip | 74127-9020
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Country | US
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Telephone | 918-599-5190
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Fax | 918-599-5818
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Provider Business Mailing Address
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Address Line | 5117 E 25TH ST
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City | TULSA
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State | OK
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Zip | 74114-3721
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Country | US
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Telephone | 918-742-5187
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT1080
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License Number State | OK
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