MEDICARE: LAURA FINE M.S.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	222Q00000X	Developmental Therapist	696193	FL

General Provider Information

NPI Number	:	1952644775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FINE M.S.ED.

Provider Business Mailing Address
First Line	:	PO BOX 740215
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33474-0215
Country	:	US
Telephone Number	:	917-699-5288
Fax Number	:

Provider Business Practice Location Address
First Line	:	8261 EMERALD WINDS CIR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-7839
Country	:	US
Telephone Number	:	917-699-5288
Fax Number	:

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

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2013

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