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General NPI Number Information
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NPI Number | 1538893029
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Entity Type | Individual
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Provider Name | KRISTIN J WIARD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 711 N 5TH ST
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City | JENKS
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State | OK
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Zip | 74037-3343
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Country | US
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Telephone | 918-299-8508
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Fax |
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Provider Business Mailing Address
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Address Line | 18617 E 46TH PL S
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City | TULSA
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State | OK
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Zip | 74134-5501
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Country | US
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Telephone | 918-946-7100
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 1304
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License Number State | OK
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