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NPI Code Detail

MEDICARE: DR. LAURA VAEZEY ROETS EDD, LADC, CTRS

MEDICARE: DR. LAURA VAEZEY ROETS EDD, LADC, CTRS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor49OK

General Provider Information

NPI Number : 1316262629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA VAEZEY ROETS EDD, LADC, CTRS
Provider Business Mailing Address
First Line : 324 N F
Second Line :
City : MUSKOGEE
State : OK
Zip : 74403-4140
Country : US
Telephone Number : 918-682-7210
Fax Number : 918-682-0801
Provider Business Practice Location Address
First Line : 2310 W BROADWAY ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-2761
Country : US
Telephone Number : 918-682-7210
Fax Number : 918-682-0801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 03/30/2010

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