MEDICARE: AMY REICHMUTH

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist	103TM1800X	OK

General Provider Information

NPI Number	:	1295128726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY REICHMUTH

Provider Business Mailing Address
First Line	:	5545 E 4TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-1613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 E 4TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-1613
Country	:	US
Telephone Number	:	918-633-6845
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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