Provider Demographics
NPI:1114653045
Name:WILBURN, KATHERINE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:WILBURN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:KOSCELNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 W WILL ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5421
Mailing Address - Country:US
Mailing Address - Phone:918-341-4343
Mailing Address - Fax:918-341-8687
Practice Address - Street 1:1110 W WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5421
Practice Address - Country:US
Practice Address - Phone:918-341-4343
Practice Address - Fax:918-341-8687
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist