MEDICARE: LAUREN NUNZIATO OTR/L

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	225X00000X	Occupational Therapist	18555	CA

General Provider Information

NPI Number	:	1861060774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN NUNZIATO OTR/L

Provider Business Mailing Address
First Line	:	9 EDWARD DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-9789
Country	:	US
Telephone Number	:	518-641-9642
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 EDWARD DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-9789
Country	:	US
Telephone Number	:	518-641-9642
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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