MEDICARE: LAKES THERAPY SERVICES

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	235Z00000X	Speech-Language Pathologist	SA 5298	FL

General Provider Information

NPI Number	:	1144582107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKES THERAPY SERVICES

Provider Business Mailing Address
First Line	:	2839 LAKE SAXON DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-6620
Country	:	US
Telephone Number	:	813-760-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 LAKE SAXON DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-6620
Country	:	US
Telephone Number	:	813-760-3730
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURA SEIVERD
Credential	:	M.S., CCC-SLP
Telephone Number	:	813-760-3730

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/14/2012

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Directions to “LAKES THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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