MEDICARE: WHITLEY HAMEN

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	106S00000X	Behavior Technician	BACB665968	OK

General Provider Information

NPI Number	:	1659949386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITLEY HAMEN

Provider Business Mailing Address
First Line	:	11812 NW 132ND ST
Second Line	:
City	:	PIEDMONT
State	:	OK
Zip	:	73078-3010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7416 BROADWAY EXT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-9069
Country	:	US
Telephone Number	:	580-278-2119
Fax Number	:

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

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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Directions to “ WHITLEY HAMEN ” Practice Location

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