MEDICARE: LAURA COLLETT

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	:	1932451788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA COLLETT

Provider Business Mailing Address
First Line	:	3721 N MILLER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7473
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3721 N MILLER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7473
Country	:	US
Telephone Number	:	405-613-2197
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “ LAURA COLLETT ” Practice Location

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