MEDICARE: DR. KIMBERLY M SCAFFETTA AUD.

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	231H00000X	Audiologist	267	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114954500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY M SCAFFETTA AUD.

Provider Business Mailing Address
First Line	:	2017 S ELM PL
Second Line	:	SUITE 107
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7034
Country	:	US
Telephone Number	:	918-451-3277
Fax Number	:	918-455-3891

Provider Business Practice Location Address
First Line	:	2017 S ELM PL
Second Line	:	SUITE 107
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7034
Country	:	US
Telephone Number	:	918-451-3277
Fax Number	:	918-455-3891

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	02/19/2008

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