MEDICARE: DR. RACHEL ASHLEY MAGANN FAIVRE AU.D.

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	231H00000X	Audiologist	9102	MN
2	231H00000X	Audiologist	4303	OK

General Provider Information

NPI Number	:	1598103574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL ASHLEY MAGANN FAIVRE AU.D.

Provider Business Mailing Address
First Line	:	2637 NW 26TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2231
Country	:	US
Telephone Number	:	815-618-8006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 NW 26TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2231
Country	:	US
Telephone Number	:	815-618-8006
Fax Number	:

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	10/19/2020

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