MEDICARE: MRS. LAURA J HOMER MPT, OCS

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	208100000X	Physical Medicine & Rehabilitation Physician	6388	CO

General Provider Information

NPI Number	:	1093728263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA J HOMER MPT, OCS

Provider Business Mailing Address
First Line	:	PO BOX 2228
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-2228
Country	:	US
Telephone Number	:	970-728-8948
Fax Number	:	970-728-8953

Provider Business Practice Location Address
First Line	:	750 WEST PACIFIC AVENUE
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-2228
Country	:	US
Telephone Number	:	970-728-8948
Fax Number	:	970-728-8953

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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