MEDICARE: MICHAEL ALLIE

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	224Z00000X	Occupational Therapy Assistant	OA307	OK

General Provider Information

NPI Number	:	1295852945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ALLIE

Provider Business Mailing Address
First Line	:	1107 N GRAND BLVD
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-3767
Country	:	US
Telephone Number	:	580-606-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 N GRAND BLVD
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-3767
Country	:	US
Telephone Number	:	580-606-0123
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/18/2010

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Directions to “ MICHAEL ALLIE ” Practice Location

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