Provider Demographics
NPI:1871712844
Name:WILMOTH, JENNIFER ANN (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WILMOTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 E 81ST ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4200
Mailing Address - Country:US
Mailing Address - Phone:918-477-5047
Mailing Address - Fax:918-477-5040
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:SUITE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-477-5047
Practice Address - Fax:918-477-5040
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist