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General NPI Number Information
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NPI Number | 1831904192
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Entity Type | Individual
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Provider Name | KELLY CARELOCK PTA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 9201 OK-17 SUITE F
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City | ELGIN
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State | OK
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Zip | 73538
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Country | US
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Telephone | 580-454-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 NE SCENIC RDG
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City | ELGIN
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State | OK
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Zip | 73538-4200
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Country | US
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Telephone | 580-574-9085
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2960
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | 2960
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License Number State | OK
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