MEDICARE: SANDRA TAYLOR

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1972988707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA TAYLOR

Provider Business Mailing Address
First Line	:	906 W 9TH PL. SOUTH
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-0000
Country	:	US
Telephone Number	:	918-342-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 W 9TH PL. SOUTH
Second Line	:
City	:	CLAREMORE
State	:	OK
Zip	:	74017-0000
Country	:	US
Telephone Number	:	918-342-1203
Fax Number	:

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

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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Directions to “ SANDRA TAYLOR ” Practice Location

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