MEDICARE: TERESA DAVIS BAIRD PH.D.

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	103T00000X	Psychologist	561	OK

General Provider Information

NPI Number	:	1811240161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA DAVIS BAIRD PH.D.

Provider Business Mailing Address
First Line	:	513 OAK SPRINGS DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-8775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3537 NE MILITARY CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-4305
Country	:	US
Telephone Number	:	405-585-7811
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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