Provider Demographics
NPI:1235919911
Name:REPSCHLAEGER, KAM L (PTA)
Entity Type:Individual
Prefix:
First Name:KAM
Middle Name:L
Last Name:REPSCHLAEGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17287 W 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4774
Mailing Address - Country:US
Mailing Address - Phone:918-280-9320
Mailing Address - Fax:
Practice Address - Street 1:17287 W 32ND ST S
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4774
Practice Address - Country:US
Practice Address - Phone:918-221-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty