MEDICARE: MARTIN DAVID MCKENZIE CASE MANAGER

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1831552504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN DAVID MCKENZIE CASE MANAGER

Provider Business Mailing Address
First Line	:	7904 S UTICA AVE APT C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7652
Country	:	US
Telephone Number	:	918-991-8034
Fax Number	:

Provider Business Practice Location Address
First Line	:	7904 S UTICA AVE APT C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7652
Country	:	US
Telephone Number	:	918-991-8034
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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