MEDICARE: VERLA-MARIE OPAL HULL B.A.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235300013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERLA-MARIE OPAL HULL B.A.

Provider Business Mailing Address
First Line	:	4436 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 N HARVEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3016
Country	:	US
Telephone Number	:	405-810-9578
Fax Number	:

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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