MEDICARE: FERNANDO AGUIRRE SPEECH THERAPIST

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	16450	TX
2	235Z00000X	Speech-Language Pathologist	4015	OK

General Provider Information

NPI Number	:	1518162841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO AGUIRRE SPEECH THERAPIST

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-355-3239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-355-3239
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	04/09/2013

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Directions to “ FERNANDO AGUIRRE SPEECH THERAPIST” Practice Location

Language	Start Address	Practice Location

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