Provider Demographics
NPI:1508241423
Name:KIRKLEY, TAMARA (SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:KIRKLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S 209TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1584
Mailing Address - Country:US
Mailing Address - Phone:918-259-4470
Mailing Address - Fax:918-355-0095
Practice Address - Street 1:4300 S 209TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-1584
Practice Address - Country:US
Practice Address - Phone:918-259-4470
Practice Address - Fax:918-355-0095
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist