MEDICARE: MRS. JANINE ANN SAUGSTAD CTRS

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	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1376504506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANINE ANN SAUGSTAD CTRS

Provider Business Mailing Address
First Line	:	714 COUNTRY GATE DR
Second Line	:
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9206
Country	:	US
Telephone Number	:	317-535-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 COUNTRY GATE DR
Second Line	:
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9206
Country	:	US
Telephone Number	:	317-535-3366
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/08/2007

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