Provider Demographics
NPI:1699705475
Name:HOOPER, SHARLY MICHELLE (M S,CCC-A)
Entity type:Individual
Prefix:
First Name:SHARLY
Middle Name:MICHELLE
Last Name:HOOPER
Suffix:
Gender:F
Credentials:M S,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 223
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-9552
Mailing Address - Country:US
Mailing Address - Phone:580-875-3423
Mailing Address - Fax:
Practice Address - Street 1:USPHS INDIAN HOSPITAL
Practice Address - Street 2:1515 LAWRIE TATUM RD
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507
Practice Address - Country:US
Practice Address - Phone:580-354-5117
Practice Address - Fax:580-354-5116
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK247231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ37615Medicare UPIN