MEDICARE: LAURA LYNN BLAIR

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1417291543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LYNN BLAIR

Provider Business Mailing Address
First Line	:	2302 S EATON CT
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 S EATON CT
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3948
Country	:	US
Telephone Number	:	303-462-0237
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ LAURA LYNN BLAIR ” Practice Location

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