MEDICARE: RESTORATIVE ALTERNATIVE WELLNESS INC

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	1041C0700X	Clinical Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518571371	OTHER	OK	NPI

General Provider Information

NPI Number	:	1518571371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE ALTERNATIVE WELLNESS INC

Provider Business Mailing Address
First Line	:	9404 BUTTONWOOD AVE
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-9137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 SW 89TH ST STE D
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6313
Country	:	US
Telephone Number	:	405-237-3780
Fax Number	:	405-237-3781

Authorized Official
Title or Position	:	OWNER
Name	:	GINA M PAZZAGLIA
Credential	:	PHD, LCSW, LADC
Telephone Number	:	405-237-3780

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	01/20/2026

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