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General NPI Number Information
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NPI Number | 1639029440
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Entity Type | Individual
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Provider Name | TARAH PALACIO
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Gender | Female
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 103 W MAIN ST
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City | MARLOW
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State | OK
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Zip | 73055-2437
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Country | US
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Telephone | 580-721-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 13981 TAG OFFICE RD
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City | FLETCHER
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State | OK
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Zip | 73541-5800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA404
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License Number State | OK
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