Provider Demographics
NPI:1285780601
Name:GARRIOTT, KARRIE LYNNE (MSPT)
Entity type:Individual
Prefix:MS
First Name:KARRIE
Middle Name:LYNNE
Last Name:GARRIOTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5663
Mailing Address - Country:US
Mailing Address - Phone:918-259-0755
Mailing Address - Fax:
Practice Address - Street 1:530 S 34TH ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5038
Practice Address - Country:US
Practice Address - Phone:918-683-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics