Provider Demographics
NPI:1245442326
Name:KALTENBAUGH, ROXENE (OTRL)
Entity type:Individual
Prefix:
First Name:ROXENE
Middle Name:
Last Name:KALTENBAUGH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 S 4350 RD
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:OK
Mailing Address - Zip Code:74369-9661
Mailing Address - Country:US
Mailing Address - Phone:918-788-3631
Mailing Address - Fax:
Practice Address - Street 1:715 N BREWER ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1426
Practice Address - Country:US
Practice Address - Phone:918-256-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT689225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist