Provider Demographics
NPI:1790369767
Name:HOWE, KRISTYN JANAE (LMT, CPMT, MMT, CPT)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:JANAE
Last Name:HOWE
Suffix:
Gender:F
Credentials:LMT, CPMT, MMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11507 S ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8012
Mailing Address - Country:US
Mailing Address - Phone:918-895-9098
Mailing Address - Fax:
Practice Address - Street 1:12820 S MEMORIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2584
Practice Address - Country:US
Practice Address - Phone:918-895-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist