MEDICARE: MRS. CHRISTINE DOOLY

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	235Z00000X	Speech-Language Pathologist	4526	OK

General Provider Information

NPI Number	:	1386031466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE DOOLY

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	JONES
State	:	OK
Zip	:	73049-0015
Country	:	US
Telephone Number	:	405-397-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	9085 HARMONY DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6217
Country	:	US
Telephone Number	:	405-397-3550
Fax Number	:

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	07/21/2022

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Directions to “ MRS. CHRISTINE DOOLY ” Practice Location

Language	Start Address	Practice Location

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