MEDICARE: MS. KARLA WHEELER

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	103K00000X	Behavior Analyst		OK

General Provider Information

NPI Number	:	1669791182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARLA WHEELER

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 600
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 600
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2433
Country	:	US
Telephone Number	:	405-521-8635
Fax Number	:	405-521-8652

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

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	05/24/2010

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