MEDICARE: MRS. LAURA SPAIN S.T.

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	SA3967	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205832060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA SPAIN S.T.

Provider Business Mailing Address
First Line	:	8455 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5066
Country	:	US
Telephone Number	:	352-860-2220
Fax Number	:	352-860-1181

Provider Business Practice Location Address
First Line	:	2210 HIGHWAY 44 W
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34453-3860
Country	:	US
Telephone Number	:	352-860-2220
Fax Number	:	352-860-1181

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. LAURA SPAIN S.T.” Practice Location

Language	Start Address	Practice Location

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