MEDICARE: DR. SALLY LYNN QUILLIAN AU.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	231H00000X	Audiologist	63	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731475099-001	OTHER	OK	STATE DEPT. OF REHAB SERV

General Provider Information

NPI Number	:	1902985328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY LYNN QUILLIAN AU.D.

Provider Business Mailing Address
First Line	:	2620 NW EXPRESSWAY ST
Second Line	:	SUITE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7207
Country	:	US
Telephone Number	:	405-947-4327
Fax Number	:	405-947-4340

Provider Business Practice Location Address
First Line	:	2620 NW EXPRESSWAY ST
Second Line	:	SUITE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7207
Country	:	US
Telephone Number	:	405-947-4327
Fax Number	:	405-947-4340

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

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	07/08/2007

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