=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497154942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHS TO INDEPENDENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 08/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4041 SHERIDAN RD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-914-9920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4041 SHERIDAN RD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER, EDUCATOR
-----------------------------------------------------
Name | MRS. CLAIR BARTLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-914-9920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2780
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------