MEDICARE: OSMARA JUDITH FAULKNER MS

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
2	235Z00000X	Speech-Language Pathologist	SA10970	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA10970	OTHER	FL	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083842769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSMARA JUDITH FAULKNER MS

Provider Business Mailing Address
First Line	:	4436 REDCOAT DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4855
Country	:	US
Telephone Number	:	813-951-3567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4436 REDCOAT DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-4855
Country	:	US
Telephone Number	:	813-873-1936
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	09/02/2014

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