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NPI Code Detail

MEDICARE: MRS. LORI H NIEBAUER

MEDICARE: MRS. LORI H NIEBAUER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1013523463
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI H NIEBAUER
Provider Business Mailing Address
First Line : 2460 ALDERBROOK DR
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-9292
Country : US
Telephone Number : 336-905-5135
Fax Number :
Provider Business Practice Location Address
First Line : 770 PARK CENTRE DR
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-3598
Country : US
Telephone Number : 336-905-5135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2020
Last Update Date : 09/21/2020

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