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Last Update: Monday, April 29, 2024 7:03 PM CDT
Next Update: Tuesday, April 30, 2024 2:50 AM CDT
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|
LARGE, KYLIE |
| Practice Address: |
BROAD RIVER REHAB - OK
1400 N WAVERLY ST
PONCA CITY OK 74601
Address last updated on 4/26/2024 |
| Phone #: |
(580) 762-6668 |
| Fax #: |
|
| County: |
KAY |
| License: |
2355 |
| Dated: |
11/1/2021 |
| Expires: |
10/31/2024 |
|
Temp.
Ltr.
Issued:
|
9/2/2021 |
|
Temp.
Ltr.
Expires:
|
11/18/2021 |
| License Type: |
Occupational Therapy Assistant |
| Specialty: |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| CME Year: |
2024 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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Primary Supervisor(s):
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| Name: |
Type: |
License Number: |
Full/Part Time: |
|
HANNELIE SMIT
|
OT |
5387 |
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