MEDICARE: CATHERINE V LAUR ATC,EMT-B,PES

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	RT005063	PA

General Provider Information

NPI Number	:	1619259371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE V LAUR ATC,EMT-B,PES

Provider Business Mailing Address
First Line	:	800 FURMAN DR
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-1912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PROSPECT ST
Second Line	:	EAST STROUDSBURG UNIVERSITY- KOEHLER FIELDHOUSE
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-2956
Country	:	US
Telephone Number	:	570-422-3231
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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