MEDICARE: O K LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750658589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O K LLC

Provider Business Mailing Address
First Line	:	28957 FORESTGROVE RD
Second Line	:
City	:	WILLOWICK
State	:	OH
Zip	:	44095-4767
Country	:	US
Telephone Number	:	216-404-7590
Fax Number	:	216-619-9066

Provider Business Practice Location Address
First Line	:	2000 LEE RD
Second Line	:	SUITE 15
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2572
Country	:	US
Telephone Number	:	216-404-7590
Fax Number	:	216-619-9066

Authorized Official
Title or Position	:	AGENT
Name	:	MS. JENNIFER T WEAVER
Credential	:
Telephone Number	:	216-404-7590

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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