MEDICARE: KELI LAW

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	390200000X	Student in an Organized Health Care Education/Training Program	22	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1063943920	OTHER	OK	VA NUMBER

General Provider Information

NPI Number	:	1760850119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELI LAW

Provider Business Mailing Address
First Line	:	5624 S VENTURA DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-5477
Country	:	US
Telephone Number	:	405-863-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	5624 S VENTURA DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-5477
Country	:	US
Telephone Number	:	405-863-1526
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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