MEDICARE: ROXANNE MELANIE LADAR

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	106S00000X	Behavior Technician		NC

General Provider Information

NPI Number	:	1003638925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE MELANIE LADAR

Provider Business Mailing Address
First Line	:	221 SAILOR WAY
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-4619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 PARK FORTY PLZ # 110
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5249
Country	:	US
Telephone Number	:	919-480-2800
Fax Number	:

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

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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Directions to “ ROXANNE MELANIE LADAR ” Practice Location

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