MEDICARE: SHAWN MARIE BILLARD PTA

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	174400000X	Specialist	TE000916L	PA

General Provider Information

NPI Number	:	1588858369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MARIE BILLARD PTA

Provider Business Mailing Address
First Line	:	HC 6 BOX 6046
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-9100
Country	:	US
Telephone Number	:	570-226-5680
Fax Number	:	570-226-5682

Provider Business Practice Location Address
First Line	:	HC 6 BOX 6046
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-9100
Country	:	US
Telephone Number	:	570-226-5680
Fax Number	:	570-226-5682

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	09/05/2007

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