MEDICARE: LAURIN SUZANNE FOLMAR OT

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	3114	MS

General Provider Information

NPI Number	:	1548639164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIN SUZANNE FOLMAR OT

Provider Business Mailing Address
First Line	:	1201 HIGHWAY 49 SOUTH
Second Line	:	SUITE 2
City	:	RICHLAND
State	:	MS
Zip	:	39218-9438
Country	:	US
Telephone Number	:	769-233-8844
Fax Number	:	769-251-1825

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S STE 2
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9438
Country	:	US
Telephone Number	:	662-289-4311
Fax Number	:

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	06/13/2017

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