Provider Demographics
NPI:1215156195
Name:BRUNSTETER MISURACA, KELLY SHANNON (OTR)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SHANNON
Last Name:BRUNSTETER MISURACA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8378
Mailing Address - Country:US
Mailing Address - Phone:405-771-4905
Mailing Address - Fax:405-945-4501
Practice Address - Street 1:5300 N INDEPENDENCE AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5550
Practice Address - Country:US
Practice Address - Phone:405-945-4500
Practice Address - Fax:405-945-4501
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT466225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand