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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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SHIVE, KELLY JOEL       
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: 111 N. BAILEY ST.
PRYOR OK 74361

Address last updated on 1/4/2024
Phone #: (918) 824-7770
Fax #:
County: MAYES
License: 1697
Dated: 9/24/2008
Expires: 1/31/2025
Temp. Ltr. Issued: 8/8/2008
Temp. Ltr. Expires: 11/7/2008
License Type: Physical Therapist Assistant
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:
111 N. BAILEY ST.
PRYOR OK 74361

Phone #: (918) 824-7770
Fax #:
Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
CASSIDY CROUCH PT 6251
JULIE HANCOX GROSSMAN PT 5019

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