Provider Demographics
NPI:1922003946
Name:SPIVA, KELLY CATHERINE (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CATHERINE
Last Name:SPIVA
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1826
Mailing Address - Country:US
Mailing Address - Phone:918-388-9090
Mailing Address - Fax:918-388-9741
Practice Address - Street 1:6802 S OLYMPIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1826
Practice Address - Country:US
Practice Address - Phone:918-388-9090
Practice Address - Fax:918-388-9741
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291231H00000X, 237700000X, 231H00000X
OK292237600000X
MO2001010827237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200233220AMedicaid
OKOK402536OtherMEDICARE PTAN