MEDICARE: MARIA THERESA LAURON OTR/L

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	225X00000X	Occupational Therapist	012948-1	NY

General Provider Information

NPI Number	:	1194037572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA THERESA LAURON OTR/L

Provider Business Mailing Address
First Line	:	20910 93RD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9052 210TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1019
Country	:	US
Telephone Number	:	718-217-1946
Fax Number	:

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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