MEDICARE: ASHLEY LAUREN WEBSTER

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	MA60750	FL

General Provider Information

NPI Number	:	1649548900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LAUREN WEBSTER

Provider Business Mailing Address
First Line	:	930 W MAIN ST
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-3312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 W MAIN ST
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-3312
Country	:	US
Telephone Number	:	863-446-2476
Fax Number	:

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

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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Directions to “ ASHLEY LAUREN WEBSTER ” Practice Location

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