MEDICARE: DONITA R TEFFT M.A., CCC-SLP

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	3107	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861500969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONITA R TEFFT M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	129 E MARIE DR
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74075-1676
Country	:	US
Telephone Number	:	580-402-2568
Fax Number	:	405-744-8070

Provider Business Practice Location Address
First Line	:	042 MURRAY
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-5062
Country	:	US
Telephone Number	:	405-744-6021
Fax Number	:	405-744-8070

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	03/17/2011

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Directions to “ DONITA R TEFFT M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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