MEDICARE: MRS. BETH-ANNE PANTAZI 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	225X00000X	Occupational Therapist	OT01005	RI
2	225X00000X	Occupational Therapist	09-0067	NV

General Provider Information

NPI Number	:	1023180304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH-ANNE PANTAZI OTR

Provider Business Mailing Address
First Line	:	8041 CRACKER BARREL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-5184
Country	:	US
Telephone Number	:	401-374-4743
Fax Number	:

Provider Business Practice Location Address
First Line	:	8041 CRACKER BARREL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-5184
Country	:	US
Telephone Number	:	401-374-4743
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	01/21/2014

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