Provider Demographics
NPI:1912509167
Name:KAMMER, DELORA MAY (LMT)
Entity Type:Individual
Prefix:
First Name:DELORA
Middle Name:MAY
Last Name:KAMMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-9103
Mailing Address - Country:US
Mailing Address - Phone:817-312-2717
Mailing Address - Fax:
Practice Address - Street 1:3909 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-9103
Practice Address - Country:US
Practice Address - Phone:817-312-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist