MEDICARE: MRS. CAROLE SIMPSON THOMPSON MED.

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

General Provider Information

NPI Number	:	1750600417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLE SIMPSON THOMPSON MED.

Provider Business Mailing Address
First Line	:	3021 NE 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2451
Country	:	US
Telephone Number	:	405-615-0785
Fax Number	:	405-424-0665

Provider Business Practice Location Address
First Line	:	3021 NE 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-2451
Country	:	US
Telephone Number	:	405-615-0785
Fax Number	:	405-424-0665

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/20/2010

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