MEDICARE: EMILY DAWN WARD PTA

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	208100000X	Physical Medicine & Rehabilitation Physician	3514	OK

General Provider Information

NPI Number	:	1508510629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DAWN WARD PTA

Provider Business Mailing Address
First Line	:	110 S SWAN DR
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4026
Country	:	US
Telephone Number	:	918-399-4717
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 S SWAN DR
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4026
Country	:	US
Telephone Number	:	918-399-4717
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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Directions to “ EMILY DAWN WARD PTA” Practice Location

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