MEDICARE: JANET MOLINA OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	914	OK

General Provider Information

NPI Number	:	1003053315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MOLINA OTR/L

Provider Business Mailing Address
First Line	:	3437 S 94TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-3519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 S 94TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-3519
Country	:	US
Telephone Number	:	918-510-7667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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