MEDICARE: MS. CECIA CLOTHER

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	C436012977100	FL

General Provider Information

NPI Number	:	1962394759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CECIA CLOTHER

Provider Business Mailing Address
First Line	:	8906 E SKELLY DR STE J
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3406
Country	:	US
Telephone Number	:	786-710-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	8906 E SKELLY DR STE J
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3406
Country	:	US
Telephone Number	:	786-710-8880
Fax Number	:

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

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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