MEDICARE: PAULINE L HAUGHTON LMT

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	174400000X	Specialist	MA56320	FL

General Provider Information

NPI Number	:	1578791547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE L HAUGHTON LMT

Provider Business Mailing Address
First Line	:	1170 INDIANA AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7307
Country	:	US
Telephone Number	:	305-490-7254
Fax Number	:	954-903-4845

Provider Business Practice Location Address
First Line	:	1170 INDIANA AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7307
Country	:	US
Telephone Number	:	305-490-7254
Fax Number	:	954-903-4845

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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