MEDICARE: MRS. MORGAN CLARISSA OLDFIELD

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
1	235Z00000X	Speech-Language Pathologist	SA 14637	FL

General Provider Information

NPI Number	:	1073928248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MORGAN CLARISSA OLDFIELD

Provider Business Mailing Address
First Line	:	96157 STONEY GLEN CT
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-6571
Country	:	US
Telephone Number	:	334-596-2679
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 OSPREY VILLAGE DR
Second Line	:
City	:	AMELIA ISLAND
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	334-596-2679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	10/03/2016

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