MEDICARE: MRS. LAURA DANT RBT

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	RBT-16-21956	NC

General Provider Information

NPI Number	:	1073001574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA DANT RBT

Provider Business Mailing Address
First Line	:	2301 CROWNPOINT EXECUTIVE DR STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-6725
Country	:	US
Telephone Number	:	704-708-8314
Fax Number	:	704-708-8315

Provider Business Practice Location Address
First Line	:	2301 CROWNPOINT EXECUTIVE DR STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-6725
Country	:	US
Telephone Number	:	704-708-8314
Fax Number	:	704-708-8315

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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