MEDICARE: MARY S STOEHR-KUNTZ TEACHER

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	390200000X	Student in an Organized Health Care Education/Training Program	821318981	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	821318981	OTHER	NY	TEACHER

General Provider Information

NPI Number	:	1881841831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY S STOEHR-KUNTZ TEACHER

Provider Business Mailing Address
First Line	:	472 SOUTH ST
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2947
Country	:	US
Telephone Number	:	716-652-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	472 SOUTH ST
Second Line	:
City	:	EAST AURORA
State	:	NY
Zip	:	14052-2947
Country	:	US
Telephone Number	:	716-652-6588
Fax Number	:

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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