Provider Demographics
NPI:1265681415
Name:RINER, JACKLYN ANNMARIE
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:ANNMARIE
Last Name:RINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 N 122ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6205
Mailing Address - Country:US
Mailing Address - Phone:918-639-2212
Mailing Address - Fax:
Practice Address - Street 1:8110 N 122ND EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6205
Practice Address - Country:US
Practice Address - Phone:918-639-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1349225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant