Provider Demographics
NPI:1366588063
Name:KAPPELLE, KATHY RENE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:RENE
Last Name:KAPPELLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23008 COUNTY ROAD 1376
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-2065
Mailing Address - Country:US
Mailing Address - Phone:405-515-9263
Mailing Address - Fax:405-515-9019
Practice Address - Street 1:23008 COUNTY ROAD 1376
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-2065
Practice Address - Country:US
Practice Address - Phone:405-515-9263
Practice Address - Fax:405-515-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100637360BMedicaid
OK100849980AMedicaid