MEDICARE: MRS. DENIQUE MARGARET THEUNISSEN

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	OC011639	PA

General Provider Information

NPI Number	:	1285079939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENIQUE MARGARET THEUNISSEN

Provider Business Mailing Address
First Line	:	1912 ALTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2802
Country	:	US
Telephone Number	:	610-823-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 ALTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2802
Country	:	US
Telephone Number	:	610-823-6604
Fax Number	:

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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