Provider Demographics
NPI:1508537796
Name:COLLIER, KYLEE JANE (PTA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:JANE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:JANE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 WEST MAIN ST.
Mailing Address - Street 2:SUITE F
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3553
Mailing Address - Country:US
Mailing Address - Phone:918-298-2381
Mailing Address - Fax:918-298-2357
Practice Address - Street 1:715 WEST MAIN ST.
Practice Address - Street 2:SUITE F
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3553
Practice Address - Country:US
Practice Address - Phone:918-298-2381
Practice Address - Fax:918-298-2357
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3633225200000X
KS14-03889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant