MEDICARE: LAURA HODGE CO

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	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1043917172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HODGE CO

Provider Business Mailing Address
First Line	:	14540 N MACKINAW HWY
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701-9507
Country	:	US
Telephone Number	:	989-497-2500
Fax Number	:	231-436-5364

Provider Business Practice Location Address
First Line	:	14540 N MACKINAW HWY
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701-9507
Country	:	US
Telephone Number	:	989-497-2500
Fax Number	:

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

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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Directions to “ LAURA HODGE CO” Practice Location

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