MEDICARE: FARINAM MOEENI PLETKA M.S.

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	235Z00000X	Speech-Language Pathologist	4252	OK

General Provider Information

NPI Number	:	1033520283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARINAM MOEENI PLETKA M.S.

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE
Second Line	:	#200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2400
Country	:	US
Telephone Number	:	403-355-3239
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 PERIMETER CENTER DR
Second Line	:	SUITE 150
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2326
Country	:	US
Telephone Number	:	403-355-3239
Fax Number	:	405-212-4270

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	12/10/2014

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