MEDICARE: LAURIE JONES

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	057.004577	IL
2	224Z00000X	Occupational Therapy Assistant	5290-27	WI

General Provider Information

NPI Number	:	1720531122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE JONES

Provider Business Mailing Address
First Line	:	107 E SOUTH ST
Second Line	:
City	:	SOUTH WAYNE
State	:	WI
Zip	:	53587-9786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 E SOUTH ST
Second Line	:
City	:	SOUTH WAYNE
State	:	WI
Zip	:	53587-9786
Country	:	US
Telephone Number	:	608-293-2358
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	07/24/2017

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Directions to “ LAURIE JONES ” Practice Location

Language	Start Address	Practice Location

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