MEDICARE: SARAH BULLOCH

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1528726395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BULLOCH

Provider Business Mailing Address
First Line	:	10401 VINEYARD BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3781
Country	:	US
Telephone Number	:	316-259-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 NW 46TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8338
Country	:	US
Telephone Number	:	316-259-8298
Fax Number	:

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

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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