MEDICARE: ADVANCE OCCUPATIONAL THERAPY, LLC

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
2	225X00000X	Occupational Therapist	102776	MN

General Provider Information

NPI Number	:	1174730899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE OCCUPATIONAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	6776 LAKE DR
Second Line	:	SUITE 220
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1156
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:	651-784-7992

Provider Business Practice Location Address
First Line	:	6776 LAKE DR
Second Line	:	SUITE 220
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1156
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:	651-784-7992

Authorized Official
Title or Position	:	CEO/ OCCUPATIONAL THERAPIST
Name	:	MRS. JENNIFER ANN CORBIN
Credential	:	MS
Telephone Number	:	651-784-7007

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	05/26/2015

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