Provider Demographics
NPI:1730353582
Name:CASTELLOW, KATHRYN (RPT, CHT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CASTELLOW
Suffix:
Gender:F
Credentials:RPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3670
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1212
Practice Address - Country:US
Practice Address - Phone:405-609-3670
Practice Address - Fax:800-506-3795
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4177225100000X
VA2305001845225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200244420AMedicaid
OKOK403112Medicare PIN