Provider Demographics
NPI:1154862969
Name:LEMKE, KAELYNN JUSTYNE (MBA, ATC, CEIS)
Entity Type:Individual
Prefix:
First Name:KAELYNN
Middle Name:JUSTYNE
Last Name:LEMKE
Suffix:
Gender:F
Credentials:MBA, ATC, CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 E APACHE ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74116-1309
Mailing Address - Country:US
Mailing Address - Phone:253-255-3115
Mailing Address - Fax:
Practice Address - Street 1:11920 E APACHE ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-1309
Practice Address - Country:US
Practice Address - Phone:253-255-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer