MEDICARE: LAURA PRIMM 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	003028-1	NY

General Provider Information

NPI Number	:	1568744373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PRIMM OTR/L

Provider Business Mailing Address
First Line	:	43 JEAN DR
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3207
Country	:	US
Telephone Number	:	631-586-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 JEAN DR
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3207
Country	:	US
Telephone Number	:	631-586-1052
Fax Number	:

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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