Provider Demographics
NPI:1710274584
Name:FERREIRA, JOY VAREE (DPT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:VAREE
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:VAREE
Other - Last Name:KINCANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3658
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:7005 SE 15TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5100
Practice Address - Country:US
Practice Address - Phone:405-610-2488
Practice Address - Fax:405-610-2484
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200340080AMedicaid
OK200340080AMedicaid