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NPI Code Detail

MEDICARE: WENDI POULSON

MEDICARE: WENDI POULSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225C00000XRehabilitation Counselor

General Provider Information

NPI Number : 1053747196
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDI POULSON
Provider Business Mailing Address
First Line : 1410 HOLLY LN
Second Line :
City : SULPHUR
State : OK
Zip : 73086-1001
Country : US
Telephone Number : 580-618-2001
Fax Number :
Provider Business Practice Location Address
First Line : 1301 KIOWA ST
Second Line :
City : ARDMORE
State : OK
Zip : 73401-2280
Country : US
Telephone Number : 580-226-9388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2013
Last Update Date : 09/20/2013

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Directions to “ WENDI POULSON ” Practice Location

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