WALLACE, KELLY JENNIFER - Licensee Information

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

WALLACE, KELLY JENNIFER

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	CUTTING EDGE PHYSICAL THERAPY 526 SW 4TH ST STE 200 MOORE OK 73160 Address last updated on 1/15/2024
Phone #:	(405) 759-2700
Fax #:	(405) 759-2722
County:	OKLAHOMA
License:	2460
Dated:	2/1/1996
Expires:	1/31/2025
License Type:	Physical Therapist
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
CUTTING EDGE PHYSICAL THERAPY 526 SW 4TH ST STE 200 MOORE OK 73160 Phone #: (405) 759-2700 Fax #: (405) 759-2722

Name:	Type:	License Number:
Primary Supervisees(s):
LISA MARIEA GUNN	TA	2379
JACOB THOMAS LIVELY	TA	3262
PEDRO L RODRIGUEZ JR.	TA	3380
REBECCA ANN SCHWARTZ	TA	3374
MICHELLE LYNN SIGLER	TA	308
ERIN ROCHELLE SKERO	TA	475

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