MEDICARE: LAURA PRIEST

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	224Z00000X	Occupational Therapy Assistant	OTA021	OH

General Provider Information

NPI Number	:	1669877833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PRIEST

Provider Business Mailing Address
First Line	:	18194 COUNTY ROAD 24
Second Line	:
City	:	GROVER HILL
State	:	OH
Zip	:	45849-9505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 N FRANKLIN ST
Second Line	:
City	:	VAN WERT
State	:	OH
Zip	:	45891-1303
Country	:	US
Telephone Number	:	419-238-1514
Fax Number	:

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

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	10/29/2014

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Directions to “ LAURA PRIEST ” Practice Location

Language	Start Address	Practice Location

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