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General NPI Number Information
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NPI Number | 1922342310
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Entity Type | Individual
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Provider Name | LAURA JEAN ALLEN CO
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Gender | Female
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 3324 GLADE ST
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City | MUSKEGON
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State | MI
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Zip | 49444-2708
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Country | US
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Telephone | 231-739-4414
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Fax | 231-739-1094
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Provider Business Mailing Address
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Address Line | 3324 GLADE ST
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City | MUSKEGON
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State | MI
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Zip | 49444-2708
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Country | US
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Telephone | 231-739-4414
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Fax | 231-739-1094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | CO004548
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License Number State | MI
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