MEDICARE: MADDISON CLAIRE OSBORNE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1316714702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDISON CLAIRE OSBORNE

Provider Business Mailing Address
First Line	:	3812 WEDGEWOOD CREEK DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-1282
Country	:	US
Telephone Number	:	405-249-5730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3812 WEDGEWOOD CREEK DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-1282
Country	:	US
Telephone Number	:	405-249-5730
Fax Number	:

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

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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Directions to “ MADDISON CLAIRE OSBORNE ” Practice Location

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