MEDICARE: GINA SELTZ

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1215654264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA SELTZ

Provider Business Mailing Address
First Line	:	1429 E 62ND ST APT D
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-0662
Country	:	US
Telephone Number	:	918-999-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 E ADMIRAL PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74115-7442
Country	:	US
Telephone Number	:	918-508-7500
Fax Number	:

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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Directions to “ GINA SELTZ ” Practice Location

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