MEDICARE: MRS. LAURIE BLANCHARD VERA MHS, OTR/L

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	225X00000X	Occupational Therapist	OT004981	GA

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	258614	OTHER		NBCOT

General Provider Information

NPI Number	:	1518292614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE BLANCHARD VERA MHS, OTR/L

Provider Business Mailing Address
First Line	:	812 CAMELLIA RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2734
Country	:	US
Telephone Number	:	706-495-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 CAMELLIA RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2734
Country	:	US
Telephone Number	:	706-495-6548
Fax Number	:

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	03/23/2011

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