=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417900960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCIA ELAINE WOODARD AU.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 HONOR HEIGHTS DR
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-683-3261
-----------------------------------------------------
Fax | 918-680-3677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1912 N 8TH ST
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74012-8139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-286-6657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 293
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------