Provider Demographics
NPI:1801809496
Name:NELDON, KAY E (OT/L, CHT)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:E
Last Name:NELDON
Suffix:
Gender:F
Credentials:OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10229 E 96TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5305
Mailing Address - Country:US
Mailing Address - Phone:918-274-8541
Mailing Address - Fax:918-274-8560
Practice Address - Street 1:10229 E 96TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5305
Practice Address - Country:US
Practice Address - Phone:918-274-8541
Practice Address - Fax:918-274-8560
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK865225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200006080AMedicaid
OK200006080AMedicaid