Provider Demographics
NPI:1437233681
Name:PATTERSON, KAROLYN MASON (PT)
Entity Type:Individual
Prefix:
First Name:KAROLYN
Middle Name:MASON
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 N BROADWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2501
Mailing Address - Country:US
Mailing Address - Phone:918-649-0919
Mailing Address - Fax:918-647-0979
Practice Address - Street 1:2104 N BROADWAY ST
Practice Address - Street 2:SUITEB
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2501
Practice Address - Country:US
Practice Address - Phone:918-640-0799
Practice Address - Fax:918-649-0797
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3521225100000X
NC10178225100000X
AR2673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079UEOtherBCBS PROVIDER
OK200107250AMedicaid
OKP00405089OtherRR MEDICARE
NC7211921Medicaid
NC10178OtherNC STATE LICENSE
OK460487007OtherTRICARE
OK200107250AMedicaid
NC079UEOtherBCBS PROVIDER
NC10178OtherNC STATE LICENSE