Provider Demographics
NPI:1790034007
Name:WEDEL-LOBSINGER, KAYLA Y
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:Y
Last Name:WEDEL-LOBSINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:Y
Other - Last Name:WEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 N. 14TH ST.
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077
Mailing Address - Country:US
Mailing Address - Phone:918-308-5512
Mailing Address - Fax:
Practice Address - Street 1:502 N. 14TH ST.
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077
Practice Address - Country:US
Practice Address - Phone:918-308-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKC082289433225C00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor