Provider Demographics
NPI:1740443886
Name:POGUE, KATHERINE FERRELL (OT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FERRELL
Last Name:POGUE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 W. BLUE STARR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5421
Mailing Address - Country:US
Mailing Address - Phone:918-342-3800
Mailing Address - Fax:918-342-3900
Practice Address - Street 1:1071 W. BLUE STARR DRIVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5421
Practice Address - Country:US
Practice Address - Phone:918-342-3800
Practice Address - Fax:918-342-3900
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9659353OtherAETNA
OKG3207OtherPREFERRED COMMUNITYCARE
025329OtherCIGNA
OK73-1601757OtherHEALTHCHOICE
73-1601757OtherTRICARE/ HUMANA
1740443886OtherBLUE CROSS BLUE SHIELD
OK200200920AMedicaid
OK200200920AMedicaid