MEDICARE: MRS. MICHELLE JANE REMKUS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1558473942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE JANE REMKUS

Provider Business Mailing Address
First Line	:	1707 N MIDWEST BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-1432
Country	:	US
Telephone Number	:	405-488-7345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8884
Country	:	US
Telephone Number	:	405-524-6500
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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