MEDICARE: JULIEN LAWRENCE

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	171WH0202X	Home Modifications Contractor	30815	TX

General Provider Information

NPI Number	:	1245675446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIEN LAWRENCE

Provider Business Mailing Address
First Line	:	PO BOX 121342
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76121-1342
Country	:	US
Telephone Number	:	817-319-6046
Fax Number	:	817-244-3242

Provider Business Practice Location Address
First Line	:	10141 CHAPEL OAK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1234
Country	:	US
Telephone Number	:	817-319-6046
Fax Number	:	817-244-3242

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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