Provider Demographics
NPI:1790452860
Name:KAUTZ, SAVANNAH LYNN
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:LYNN
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 W 151ST ST S
Mailing Address - Street 2:
Mailing Address - City:KELLYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74039-6109
Mailing Address - Country:US
Mailing Address - Phone:918-606-6828
Mailing Address - Fax:
Practice Address - Street 1:1215 S BOULDER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-2842
Practice Address - Country:US
Practice Address - Phone:918-631-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer