MEDICARE: CINDA CASE DIRLAM P.T.A.

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	246Z00000X	Other Specialist/Technologist	TE 000211L	PA

General Provider Information

NPI Number	:	1518036409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDA CASE DIRLAM P.T.A.

Provider Business Mailing Address
First Line	:	24 DIRLAM BLVD
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-7510
Country	:	US
Telephone Number	:	570-253-0756
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 6 BOX 6046
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-9100
Country	:	US
Telephone Number	:	570-226-5680
Fax Number	:	570-226-5682

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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