MEDICARE: LARA DUBOIS OT/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	225XP0200X	Pediatric Occupational Therapist	1118	NH

General Provider Information

NPI Number	:	1902241714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA DUBOIS OT/L

Provider Business Mailing Address
First Line	:	1 BAYSIDE RD # 109
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2117
Country	:	US
Telephone Number	:	603-373-0014
Fax Number	:	603-433-6787

Provider Business Practice Location Address
First Line	:	1 BAYSIDE RD # 109
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2117
Country	:	US
Telephone Number	:	603-373-0014
Fax Number	:	603-433-6787

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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Directions to “ LARA DUBOIS OT/L” Practice Location

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