MEDICARE: MRS. LAURA CROWE SOBOL 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	225XP0200X	Pediatric Occupational Therapist	OT 3376	GA

General Provider Information

NPI Number	:	1780825299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA CROWE SOBOL OTR/L

Provider Business Mailing Address
First Line	:	3334 PEACHTREE RD NE
Second Line	:	SUITE #1507
City	:	ATLANTA
State	:	GA
Zip	:	30326-6801
Country	:	US
Telephone Number	:	404-798-8809
Fax Number	:	404-201-2928

Provider Business Practice Location Address
First Line	:	3334 PEACHTREE RD NE
Second Line	:	SUITE #1507
City	:	ATLANTA
State	:	GA
Zip	:	30326-6801
Country	:	US
Telephone Number	:	404-798-8809
Fax Number	:	404-201-2928

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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