=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124142161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERI ANN GROTTS BA BHRS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 ALAMEDA ST
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-573-3935
-----------------------------------------------------
Fax | 405-573-3958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5803 HICKORY BEND DR
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73026-0964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-1118
-----------------------------------------------------
Fax | 405-573-3958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------