MEDICARE: PAULINE LAUBACHER

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	225XP0019X	Physical Rehabilitation Occupational Therapist	6137	AZ

General Provider Information

NPI Number	:	1275079675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE LAUBACHER

Provider Business Mailing Address
First Line	:	13531 W FARGO DR
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-5374
Country	:	US
Telephone Number	:	601-686-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W NORTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5469
Country	:	US
Telephone Number	:	602-535-8255
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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Directions to “ PAULINE LAUBACHER ” Practice Location

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