MEDICARE: MS. LAURA CERULLO DENIS OTR/L

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	172V00000X	Community Health Worker	005397-1	NY

General Provider Information

NPI Number	:	1306081450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA CERULLO DENIS OTR/L

Provider Business Mailing Address
First Line	:	122 FIRE HILL RD
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-3532
Country	:	US
Telephone Number	:	203-438-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 FIRE HILL RD
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-3532
Country	:	US
Telephone Number	:	203-438-2230
Fax Number	:

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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