CRISP, MATTHEW - Licensee Information - Oklahoma Medical Board

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

CRISP, MATTHEW

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:	IGNITE MEDICAL RESORT 6312 N PORTLAND AVE OKLAHOMA CITY OK 73112 Address last updated on 4/10/2024
Phone #:
Fax #:
County:	OKLAHOMA
License:	5427
Dated:	12/8/2017
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:
IGNITE MEDICAL RESORT 6312 N PORTLAND AVE OKLAHOMA CITY OK 73112 Phone #: Fax #:

Name:	Type:	License Number:
Primary Supervisees(s):
DEBRA ANN ALEXANDER	TA	1576
LUIS FERNANDO AVELINO	TA	3742
LAURYN ASHLEIGH BECERRA	TA	3537
JADE KOREY BELL	TA	2036
REGAN COIL	TA	3151
LAUREN NICOLE COLEMAN	TA	3123
HAYLEY MARIE COOTS	TA	3203
ZORRO W DANIELS	TA	3589
MADISON KELLY DEGRAFFENREID	TA	2679
BROOKE ASHLYN DILLINGER	TA	3479
LESLIE CATHERINE FUENTES	TA	2163
WESUI CHAUNTE' GILMORE	TA	2049
JOHN MICHAEL HAMMON	TA	1148
BRANDI LASHELLE HARRIS	TA	2677
SHELBY MARIE LOPEZ	TA	3073
LARESA DAWN MILLER	TA	2706
TAYLOR SHEA MOSELEY	TA	3373
PIERRE NGALANI	TA	2380

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