MEDICARE: SHIRLEY WILLIAMS

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		OK

General Provider Information

NPI Number	:	1992232763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY WILLIAMS

Provider Business Mailing Address
First Line	:	809 SW 89TH ST
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9360
Country	:	US
Telephone Number	:	405-634-1497
Fax Number	:	405-634-1919

Provider Business Practice Location Address
First Line	:	809 SW 89TH ST
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9360
Country	:	US
Telephone Number	:	405-634-1497
Fax Number	:	405-634-1919

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “ SHIRLEY WILLIAMS ” Practice Location

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