MEDICARE: AJAI WALTERS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1770913691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAI WALTERS

Provider Business Mailing Address
First Line	:	1319 NE 8TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-2201
Country	:	US
Telephone Number	:	405-604-5303
Fax Number	:	405-604-5303

Provider Business Practice Location Address
First Line	:	1319 NE 8TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-2201
Country	:	US
Telephone Number	:	405-604-5303
Fax Number	:	405-604-5303

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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