MEDICARE: MS. RACHEL CHANEY

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	235Z00000X	Speech-Language Pathologist	3129	OK

General Provider Information

NPI Number	:	1770702326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL CHANEY

Provider Business Mailing Address
First Line	:	2 W MAIN ST
Second Line	:	SUITE 200
City	:	ARDMORE
State	:	OK
Zip	:	73401-6505
Country	:	US
Telephone Number	:	580-223-3383
Fax Number	:	580-223-6696

Provider Business Practice Location Address
First Line	:	2 W MAIN ST
Second Line	:	SUITE 200
City	:	ARDMORE
State	:	OK
Zip	:	73401-6505
Country	:	US
Telephone Number	:	580-223-3383
Fax Number	:	580-223-6696

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/09/2007

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Directions to “ MS. RACHEL CHANEY ” Practice Location

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