MEDICARE: MRS. SHARI LEANN HOLDER R.P.T.

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	174400000X	Specialist	2658	OK

General Provider Information

NPI Number	:	1013968544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARI LEANN HOLDER R.P.T.

Provider Business Mailing Address
First Line	:	10411 E 114TH ST S
Second Line	:
City	:	BIXBY
State	:	OK
Zip	:	74008-2838
Country	:	US
Telephone Number	:	918-369-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 S HARVARD AVE
Second Line	:	SUITE #455
City	:	TULSA
State	:	OK
Zip	:	74135-3055
Country	:	US
Telephone Number	:	918-712-7805
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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