MEDICARE: SHARLEEN LOUISE DEWANE

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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1598036055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARLEEN LOUISE DEWANE

Provider Business Mailing Address
First Line	:	5546 N PORTLAND AVE
Second Line	:	APT 260
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1913
Country	:	US
Telephone Number	:	405-837-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 N PORTLAND AVE
Second Line	:	APT 260
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1913
Country	:	US
Telephone Number	:	405-837-7614
Fax Number	:

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

Provider Enumeration Date	:	01/14/2012
Last Update Date	:	01/14/2012

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Directions to “ SHARLEEN LOUISE DEWANE ” Practice Location

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