MEDICARE: SHELLI R. SIMMONS

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1629342464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLI R. SIMMONS

Provider Business Mailing Address
First Line	:	PO BOX 11753
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73136-0753
Country	:	US
Telephone Number	:	405-802-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 NE 18TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-1628
Country	:	US
Telephone Number	:	405-802-2557
Fax Number	:

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	02/24/2012

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Directions to “ SHELLI R. SIMMONS ” Practice Location

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