Provider Demographics
NPI:1699454488
Name:KIRCHNER, KANON (PTA)
Entity type:Individual
Prefix:
First Name:KANON
Middle Name:
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CREEKSIDE DR APT 2301
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1937
Mailing Address - Country:US
Mailing Address - Phone:405-535-9151
Mailing Address - Fax:
Practice Address - Street 1:2475 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6384
Practice Address - Country:US
Practice Address - Phone:405-447-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3504225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant