MEDICARE: TERRI EISEL OT

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	225XH1200X	Hand Occupational Therapist	OT002823	OH

General Provider Information

NPI Number	:	1306875943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI EISEL OT

Provider Business Mailing Address
First Line	:	200 E CALIFORNIA AVE
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5658
Country	:	US
Telephone Number	:	330-965-9330
Fax Number	:	330-965-9308

Provider Business Practice Location Address
First Line	:	2959 CANFIELD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44511-2800
Country	:	US
Telephone Number	:	330-799-6298
Fax Number	:	330-799-4867

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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Directions to “ TERRI EISEL OT” Practice Location

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