=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366588063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY RENE KAPPELLE P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23008 COUNTY ROAD 1376
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-515-9263
-----------------------------------------------------
Fax | 405-515-9019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23008 COUNTY ROAD 1376
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-515-9263
-----------------------------------------------------
Fax | 405-515-9019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT1428
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------