Provider Demographics
NPI:1164990362
Name:PASCHAL-WILSON, KIRSTEN SHAYNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:SHAYNE
Last Name:PASCHAL-WILSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:SHAYNE
Other - Last Name:PASCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:801 SHADOWLAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6895
Mailing Address - Country:US
Mailing Address - Phone:405-227-3269
Mailing Address - Fax:
Practice Address - Street 1:721 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1205
Practice Address - Country:US
Practice Address - Phone:405-609-3688
Practice Address - Fax:877-887-5107
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist