MEDICARE: LINDA RAE SEALEY

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	2629	OK

General Provider Information

NPI Number	:	1497847172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA RAE SEALEY

Provider Business Mailing Address
First Line	:	315 LISA LANE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044
Country	:	US
Telephone Number	:	405-282-1620
Fax Number	:	405-744-8070

Provider Business Practice Location Address
First Line	:	110 HANNER
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74078-5062
Country	:	US
Telephone Number	:	405-744-6021
Fax Number	:	405-744-8070

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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Directions to “ LINDA RAE SEALEY ” Practice Location

Language	Start Address	Practice Location

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