Provider Demographics
NPI:1417374299
Name:PASSMORE, JONETTE KAY (CTRS/L, ATRIC)
Entity Type:Individual
Prefix:MRS
First Name:JONETTE
Middle Name:KAY
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:CTRS/L, ATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2101
Mailing Address - Country:US
Mailing Address - Phone:405-334-9444
Mailing Address - Fax:
Practice Address - Street 1:3124 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-2101
Practice Address - Country:US
Practice Address - Phone:405-334-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist