Provider Demographics
NPI:1902238157
Name:KETCH, KRISTIN COLE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:COLE
Last Name:KETCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NW 150TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1525
Mailing Address - Country:US
Mailing Address - Phone:405-831-5893
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 150TH TER
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1525
Practice Address - Country:US
Practice Address - Phone:405-831-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK978283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital