Provider Demographics
NPI:1285876482
Name:KLECK, EMILY CORINN (OTR)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CORINN
Last Name:KLECK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7112 S MINGO RD
Mailing Address - Street 2:STE 108
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3201
Mailing Address - Country:US
Mailing Address - Phone:918-250-7093
Mailing Address - Fax:918-250-9976
Practice Address - Street 1:7112 S MINGO RD
Practice Address - Street 2:STE 108
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3201
Practice Address - Country:US
Practice Address - Phone:918-250-7093
Practice Address - Fax:918-250-9976
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1563225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics