MEDICARE: LIA NICOLE ROHLEHR M.A.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639514300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIA NICOLE ROHLEHR M.A.

Provider Business Mailing Address
First Line	:	484 ROQUETTE AVE
Second Line	:
City	:	SOUTH FLORAL PARK
State	:	NY
Zip	:	11001-3542
Country	:	US
Telephone Number	:	516-658-8901
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 ROQUETTE AVE
Second Line	:
City	:	SOUTH FLORAL PARK
State	:	NY
Zip	:	11001-3542
Country	:	US
Telephone Number	:	516-658-8901
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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