MEDICARE: SHAYLA JOHNSON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134595606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA JOHNSON

Provider Business Mailing Address
First Line	:	5201 N MICHIGAN ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7028
Country	:	US
Telephone Number	:	405-200-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 N MICHIGAN ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7028
Country	:	US
Telephone Number	:	405-200-6665
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ SHAYLA JOHNSON ” Practice Location

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