Provider Demographics
NPI:1881234581
Name:CASE, KRISTEN KAYE (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAYE
Last Name:CASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:KAYE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2630 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-4010
Mailing Address - Country:US
Mailing Address - Phone:580-256-2102
Mailing Address - Fax:580-256-1410
Practice Address - Street 1:2630 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-4010
Practice Address - Country:US
Practice Address - Phone:580-256-2102
Practice Address - Fax:580-256-1410
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist