Provider Demographics
NPI:1538311824
Name:DUNLAP, JESSICA KALI (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KALI
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KALI
Other - Last Name:FICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 721505
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8163
Mailing Address - Country:US
Mailing Address - Phone:405-872-1550
Mailing Address - Fax:405-872-1510
Practice Address - Street 1:207 EAST ELM
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068
Practice Address - Country:US
Practice Address - Phone:405-872-1550
Practice Address - Fax:405-872-1510
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist