MEDICARE: MRS. OLGA BEATRIZ SIMONS MSW

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	1041C0700X	Clinical Social Worker	LCSW-1228	ID
2	1041C0700X	Clinical Social Worker	LCSW-1228	AR

General Provider Information

NPI Number	:	1922097823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLGA BEATRIZ SIMONS MSW

Provider Business Mailing Address
First Line	:	7050 AIR DEPOT BLVD BLDG 1094
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8716
Country	:	US
Telephone Number	:	405-582-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARNOLD ST
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8105
Country	:	US
Telephone Number	:	405-734-4393
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/07/2018

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