Provider Demographics
NPI:1639316383
Name:SAMS, KORY (CPED, RPOA)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:SAMS
Suffix:
Gender:M
Credentials:CPED, RPOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4614
Mailing Address - Country:US
Mailing Address - Phone:918-742-6464
Mailing Address - Fax:918-742-9933
Practice Address - Street 1:2116 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4614
Practice Address - Country:US
Practice Address - Phone:918-742-6464
Practice Address - Fax:918-742-9933
Is Sole Proprietor?:No
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRPOA6225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter