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NPI Code Detail

MEDICARE: MRS. FELICIA AVE HOLLIS BSW, CM

MEDICARE:  MRS. FELICIA AVE HOLLIS  BSW, CM
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
1104100000XSocial WorkerOK

General Provider Information

NPI Number : 1770892259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. FELICIA AVE HOLLIS BSW, CM
Provider Business Mailing Address
First Line : 8420 NW 125TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-2533
Country : US
Telephone Number : 405-471-3601
Fax Number :
Provider Business Practice Location Address
First Line : 5350 S WESTERN AVE STE 542
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-4536
Country : US
Telephone Number : 405-889-1562
Fax Number : 877-632-2235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2010
Last Update Date : 05/24/2021

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Directions to “ MRS. FELICIA AVE HOLLIS BSW, CM” Practice Location

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