Provider Demographics
NPI:1093318701
Name:KOK, JENNA LYNN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:KOK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-2403
Mailing Address - Country:US
Mailing Address - Phone:469-834-6668
Mailing Address - Fax:
Practice Address - Street 1:1255 WEST 15TH ST SUITE 1025
Practice Address - Street 2:1255
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:214-995-1728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist