MEDICARE: ZOE LAFERRIERE L-ATC

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	2255A2300X	Athletic Trainer
2	2255A2300X	Athletic Trainer	AT751	ME

General Provider Information

NPI Number	:	1518466226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE LAFERRIERE L-ATC

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	GRAY
State	:	ME
Zip	:	04039-0187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 SLIGO RD
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6207
Country	:	US
Telephone Number	:	207-572-7081
Fax Number	:

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	01/08/2023

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