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NPI Code Detail

MEDICARE: MRS. KIMBERLY DAWN SPIVEY M.E.D CCC-SLP

MEDICARE: MRS. KIMBERLY DAWN SPIVEY M.E.D CCC-SLP
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
1235Z00000XSpeech-Language Pathologist920OK

General Provider Information

NPI Number : 1700048394
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY DAWN SPIVEY M.E.D CCC-SLP
Provider Business Mailing Address
First Line : 4100 S DOUGLAS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3210
Country : US
Telephone Number : 405-644-5445
Fax Number : 405-636-7178
Provider Business Practice Location Address
First Line : 4100 S DOUGLAS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3210
Country : US
Telephone Number : 405-644-5445
Fax Number : 405-636-7178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2008
Last Update Date : 06/25/2008

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Directions to “ MRS. KIMBERLY DAWN SPIVEY M.E.D CCC-SLP” Practice Location

Language Start Address Practice Location
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