MEDICARE: MR. JOHN EDWARD LANE JR. OTR

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	225XH1300X	Human Factors Occupational Therapist	0405	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11446001	OTHER	NH	CAQH ID

General Provider Information

NPI Number	:	1992871792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN EDWARD LANE JR. OTR

Provider Business Mailing Address
First Line	:	21 BURNSIDE STREET
Second Line	:
City	:	LANCASTER
State	:	NH
Zip	:	03584-3241
Country	:	US
Telephone Number	:	603-381-0101
Fax Number	:	603-788-3720

Provider Business Practice Location Address
First Line	:	21 BURNSIDE STREET
Second Line	:
City	:	LANCASTER
State	:	NH
Zip	:	03584-3241
Country	:	US
Telephone Number	:	603-381-0101
Fax Number	:	603-788-3720

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/09/2007

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