MEDICARE: TARA RENEE WARWICK OTR/L

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	225X00000X	Occupational Therapist	OT 1098	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437114949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA RENEE WARWICK OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 30034
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-0001
Country	:	US
Telephone Number	:	405-503-6639
Fax Number	:	866-435-3297

Provider Business Practice Location Address
First Line	:	9636 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2727
Country	:	US
Telephone Number	:	405-503-6639
Fax Number	:	866-435-3297

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	04/07/2009

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