MEDICARE: DR. TREVOR PAUL COUROULEAU AU.D.

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	231H00000X	Audiologist	351	OK

General Provider Information

NPI Number	:	1376598102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR PAUL COUROULEAU AU.D.

Provider Business Mailing Address
First Line	:	42 MURRAY HALL
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-1215
Country	:	US
Telephone Number	:	405-744-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 MURRAY HALL
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-0001
Country	:	US
Telephone Number	:	405-341-1800
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/21/2018

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