MEDICARE: MRS. MARY ELAINE M OSBORNE

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	231H00000X	Audiologist	4239	LA
2	235500000X	Speech/Language/Hearing Specialist/Technologist	4239	LA

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
2	4239	OTHER	LA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1326076720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELAINE M OSBORNE

Provider Business Mailing Address
First Line	:	1100 N VICTOR II BLVD
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1331
Country	:	US
Telephone Number	:	985-385-4327
Fax Number	:	985-385-1988

Provider Business Practice Location Address
First Line	:	1100 N VICTOR II BLVD
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1331
Country	:	US
Telephone Number	:	985-385-4327
Fax Number	:	985-385-1988

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/15/2016

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