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General NPI Number Information
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NPI Number | 1841877255
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Entity Type | Individual
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Provider Name | KELBY DAWN KOONCE PTA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 1400 E VANBUREN
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City | MCALESTER
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State | OK
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Zip | 74501
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Country | US
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Telephone | 918-421-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 101 OKLAHOMA AVE
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City | MCALESTER
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State | OK
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Zip | 74501-7520
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Country | US
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Telephone | 918-423-4900
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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 | 3233
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License Number State | OK
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