MEDICARE: ANDREW CASSELL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851972905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CASSELL

Provider Business Mailing Address
First Line	:	7136 S YALE AVE STE 220
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6356
Country	:	US
Telephone Number	:	918-951-5742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4934 E 73RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7007
Country	:	US
Telephone Number	:	918-913-0430
Fax Number	:

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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Directions to “ ANDREW CASSELL ” Practice Location

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