Provider Demographics
NPI:1740402775
Name:JORDAN, CATHY LOUISE (MS, CTRS)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:LOUISE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12708 W 128TH ST
Mailing Address - Street 2:
Mailing Address - City:COYLE
Mailing Address - State:OK
Mailing Address - Zip Code:73027-2401
Mailing Address - Country:US
Mailing Address - Phone:405-466-2694
Mailing Address - Fax:405-742-4976
Practice Address - Street 1:1323 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4306
Practice Address - Country:US
Practice Address - Phone:405-742-5787
Practice Address - Fax:405-742-4976
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist