MEDICARE: LAURA GRACE KLINE

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1265398655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GRACE KLINE

Provider Business Mailing Address
First Line	:	700 N WAVERLY ST
Second Line	:
City	:	SHILLINGTON
State	:	PA
Zip	:	19607-1206
Country	:	US
Telephone Number	:	610-507-4418
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N WAVERLY ST
Second Line	:
City	:	SHILLINGTON
State	:	PA
Zip	:	19607-1206
Country	:	US
Telephone Number	:	610-507-4418
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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Directions to “ LAURA GRACE KLINE ” Practice Location

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