MEDICARE: SHAELLEN ELIZABETH FLORA

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	224Z00000X	Occupational Therapy Assistant	2201	OK

General Provider Information

NPI Number	:	1750059069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAELLEN ELIZABETH FLORA

Provider Business Mailing Address
First Line	:	629 SW 89TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9337
Country	:	US
Telephone Number	:	405-493-9955
Fax Number	:	405-768-2488

Provider Business Practice Location Address
First Line	:	629 SW 89TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9337
Country	:	US
Telephone Number	:	405-493-9955
Fax Number	:	405-768-2488

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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Directions to “ SHAELLEN ELIZABETH FLORA ” Practice Location

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