MEDICARE: MS. MICHELLE MARIA SABOL MS

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	235Z00000X	Speech-Language Pathologist	2202004973	VA

General Provider Information

NPI Number	:	1346205895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MARIA SABOL MS

Provider Business Mailing Address
First Line	:	161 LAKE HOLIDAY RD
Second Line	:
City	:	CROSS JUNCTION
State	:	VA
Zip	:	22625-2410
Country	:	US
Telephone Number	:	540-888-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 LAKE HOLIDAY RD
Second Line	:
City	:	CROSS JUNCTION
State	:	VA
Zip	:	22625-2410
Country	:	US
Telephone Number	:	540-888-4946
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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