Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 15679 | OK |
N | 207QS0010X | Family Doctor - Sports Medicine | 15679 | OK |
NPI | 1134196207 |
---|---|
Provider Name | Kathryn E Reilly |
First Address | Oklahoma City, OK 73117-1039 |
Second Address | Oklahoma City, OK 73104-5420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 06/01/2014 |