Provider Demographics
NPI:1295972941
Name:KESTER, GARY (CO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KESTER
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 5TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5860
Mailing Address - Country:US
Mailing Address - Phone:580-237-7654
Mailing Address - Fax:580-237-2211
Practice Address - Street 1:330 S 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5860
Practice Address - Country:US
Practice Address - Phone:580-237-7654
Practice Address - Fax:580-237-2211
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO19222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist