MEDICARE: MS. LAURIE CAPP

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1528038742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE CAPP

Provider Business Mailing Address
First Line	:	1222 SPRUCE ST
Second Line	:	RM 2.102A, ISC ST LOUIS (PK)
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2818
Country	:	US
Telephone Number	:	314-539-3900
Fax Number	:	314-539-3904

Provider Business Practice Location Address
First Line	:	1222 SPRUCE ST
Second Line	:	RM 2.102A, ISC ST LOUIS (PK)
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2818
Country	:	US
Telephone Number	:	314-539-3900
Fax Number	:	314-539-3904

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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