MEDICARE: EMILY DIANE SCHANTZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1942528625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DIANE SCHANTZ

Provider Business Mailing Address
First Line	:	1711 E LINDSEY ST
Second Line	:	#4
City	:	NORMAN
State	:	OK
Zip	:	73071-2448
Country	:	US
Telephone Number	:	405-615-3631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 N MERIDIAN AVE
Second Line	:	SUITE 104
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2853
Country	:	US
Telephone Number	:	405-602-0835
Fax Number	:	405-602-0936

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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