Provider Demographics
NPI:1700627502
Name:PUCKETT, KATHRYN CLAIRE (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLAIRE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 WATERFORD BLVD APT 63
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1110
Mailing Address - Country:US
Mailing Address - Phone:405-464-0800
Mailing Address - Fax:
Practice Address - Street 1:1824 COMMONS CIR STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9538
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:405-467-6100
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist