MEDICARE: MRS. LAURA ANNRQ NOVOTNY MS ED

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	235Z00000X	Speech-Language Pathologist	SP-5422	OH

General Provider Information

NPI Number	:	1538562392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ANNRQ NOVOTNY MS ED

Provider Business Mailing Address
First Line	:	9620 TILBY RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-1255
Country	:	US
Telephone Number	:	440-465-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 W 140TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-4972
Country	:	US
Telephone Number	:	216-920-7000
Fax Number	:

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

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	10/07/2014

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Directions to “ MRS. LAURA ANNRQ NOVOTNY MS ED” Practice Location

Language	Start Address	Practice Location

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