MEDICARE: OBA WOODYARD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1710286778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBA WOODYARD

Provider Business Mailing Address
First Line	:	2323 HANSEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-4859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 HANSEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-4859
Country	:	US
Telephone Number	:	850-894-3700
Fax Number	:	850-894-3702

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

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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Directions to “ OBA WOODYARD ” Practice Location

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