Provider Demographics
NPI:1184928087
Name:PLUMMER, KATHLEEN L (COTA, VRA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:COTA, VRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5007
Mailing Address - Country:US
Mailing Address - Phone:405-232-4644
Mailing Address - Fax:405-231-0238
Practice Address - Street 1:501 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5007
Practice Address - Country:US
Practice Address - Phone:405-232-4644
Practice Address - Fax:405-231-0238
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK989224Z00000X, 224ZL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant