Provider Demographics
NPI:1598975245
Name:HOLMES, KELLLI (PT)
Entity Type:Individual
Prefix:
First Name:KELLLI
Middle Name:
Last Name:HOLMES
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 1:12005 MOON BEAM DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1057
Mailing Address - Country:US
Mailing Address - Phone:405-722-4599
Mailing Address - Fax:
Practice Address - Street 1:4219 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3410
Practice Address - Country:US
Practice Address - Phone:405-644-5297
Practice Address - Fax:405-644-5390
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist