Provider Demographics
NPI:1134636673
Name:CONLEY, KAREN ANN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JAMES RAY RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5640
Mailing Address - Country:US
Mailing Address - Phone:405-585-3926
Mailing Address - Fax:
Practice Address - Street 1:11 JAMES RAY RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-5640
Practice Address - Country:US
Practice Address - Phone:405-585-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1596208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty