Provider Demographics
NPI:1215530381
Name:FERRELL, KRISTINE Z (CTRS)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:Z
Last Name:FERRELL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 REDVINE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4236
Mailing Address - Country:US
Mailing Address - Phone:405-921-6852
Mailing Address - Fax:
Practice Address - Street 1:921 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-8215
Practice Address - Country:US
Practice Address - Phone:405-456-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK441225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
44245OtherCERTIFIED RECREATION THERAPIST