Provider Demographics
NPI:1720261647
Name:PROUD, KIERA R (OTR)
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:R
Last Name:PROUD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIERA
Other - Middle Name:R
Other - Last Name:UNSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3327 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5627
Mailing Address - Country:US
Mailing Address - Phone:405-946-7300
Mailing Address - Fax:405-946-7306
Practice Address - Street 1:3327 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5627
Practice Address - Country:US
Practice Address - Phone:405-946-7300
Practice Address - Fax:405-946-7306
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1637225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand