Provider Demographics
NPI:1437829108
Name:QUARTERSON, KATIE JOY (OTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JOY
Last Name:QUARTERSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JOY
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9810 N 136TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4563
Mailing Address - Country:US
Mailing Address - Phone:918-520-4968
Mailing Address - Fax:
Practice Address - Street 1:BARTLESVILLE HOPE PEDIATRICS
Practice Address - Street 2:117 W 5TH ST SUITE 001
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-977-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2227224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0148Medicaid