MEDICARE: JO-ANN ELIZABETH LOBBAN

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	222Q00000X	Developmental Therapist		FL

General Provider Information

NPI Number	:	1629504139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO-ANN ELIZABETH LOBBAN

Provider Business Mailing Address
First Line	:	4511 NW 74TH AVE
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4046
Country	:	US
Telephone Number	:	954-394-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 NW 74TH AVE
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4046
Country	:	US
Telephone Number	:	954-394-0842
Fax Number	:

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	12/06/2017

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