MEDICARE: MRS. AUDREY ROSE ART

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

General Provider Information

NPI Number	:	1669744249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDREY ROSE ART

Provider Business Mailing Address
First Line	:	170 PLEASANT ST
Second Line	:	ROOM 100
City	:	FALL RIVER
State	:	MA
Zip	:	02721-3015
Country	:	US
Telephone Number	:	774-294-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 PLEASANT ST
Second Line	:	ROOM 100
City	:	FALL RIVER
State	:	MA
Zip	:	02721-3015
Country	:	US
Telephone Number	:	774-294-5722
Fax Number	:

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	08/15/2013

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