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Oklahoma Board of Medical Licensure and Supervision

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

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GENTRY, SUSAN RENEE'       
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: GRAND LAKE VILLA
103 HARBER ROAD
GROVE OK 74344

Address last updated on 8/27/2024
Phone #: (918) 786-2276
Fax #: (918) 786-2277
County: DELAWARE
License: 3090
Dated: 10/26/2000
Expires: 1/31/2025
Temp. Ltr. Issued: 3/10/2005
Temp. Ltr. Expires: 5/5/2005
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:
GRAND LAKE VILLA
103 HARBER ROAD
GROVE OK 74344

Phone #: (918) 786-2276
Fax #: (918) 786-2277
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
LISA K EAST TA 1762
ANDREW SCOTT LITTLEJOHN TA 1509
MICAH JEROD LITTLEJOHN TA 1741

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