Provider Demographics
NPI:1922457316
Name:KRITZ, SALLY ABIGAIL (BA)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:ABIGAIL
Last Name:KRITZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:SALLY
Other - Middle Name:ABIGAIL
Other - Last Name:COPLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:2400 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4434
Mailing Address - Country:US
Mailing Address - Phone:620-515-5131
Mailing Address - Fax:
Practice Address - Street 1:14625 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8728
Practice Address - Country:US
Practice Address - Phone:405-390-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program