MEDICARE: MS. TARA LYNN BRANSTETTER M.S.

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	235Z00000X	Speech-Language Pathologist		OK

General Provider Information

NPI Number	:	1659504983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA LYNN BRANSTETTER M.S.

Provider Business Mailing Address
First Line	:	3116 CENTER ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2404
Country	:	US
Telephone Number	:	405-612-2448
Fax Number	:	405-720-9815

Provider Business Practice Location Address
First Line	:	3116 CENTER ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2404
Country	:	US
Telephone Number	:	405-612-2448
Fax Number	:	405-720-9815

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

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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