MEDICARE: MS. LAUREL PAULINE QUARLES

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	225XP0200X	Pediatric Occupational Therapist	11051	CA

General Provider Information

NPI Number	:	1487814703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL PAULINE QUARLES

Provider Business Mailing Address
First Line	:	1150 S BASCOM AVE STE 8
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3509
Country	:	US
Telephone Number	:	408-885-9000
Fax Number	:	408-885-9009

Provider Business Practice Location Address
First Line	:	1150 S BASCOM AVE STE 8
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3509
Country	:	US
Telephone Number	:	408-885-9000
Fax Number	:	408-885-9009

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	12/06/2012

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