MEDICARE: VIRGINIA ALLENSWORTH

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	103TR0400X	Rehabilitation Psychologist
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1942430251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA ALLENSWORTH

Provider Business Mailing Address
First Line	:	HC 63 BOX 2100
Second Line	:	107 N. 4410 RD.
City	:	FT TOWSON
State	:	OK
Zip	:	74735-9256
Country	:	US
Telephone Number	:	580-579-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 63 BOX 2100
Second Line	:	107 N. 4410 RD.
City	:	FT TOWSON
State	:	OK
Zip	:	74735-9256
Country	:	US
Telephone Number	:	580-579-8172
Fax Number	:

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/06/2015

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Directions to “ VIRGINIA ALLENSWORTH ” Practice Location

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