Provider Demographics
NPI:1104212224
Name:GREER, KATHY KINCHELOE (COTA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:KINCHELOE
Last Name:GREER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:5401 WEST 191ST SOUTH
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-0008
Mailing Address - Country:US
Mailing Address - Phone:918-827-3307
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DRIVE
Practice Address - Street 2:SUITE #402
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-827-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant