=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144666868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SHEILA D JONES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2013
-----------------------------------------------------
Last Update Date | 05/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E MAIN ST
-----------------------------------------------------
City | TISHOMINGO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73460-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-839-0581
-----------------------------------------------------
Fax | 918-647-2385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 WILSON AVENUE APT 3
-----------------------------------------------------
City | POTEAU
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-839-0581
-----------------------------------------------------
Fax | 918-647-2385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Psychologist
-----------------------------------------------------
License Number | 103TR0400X
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------