MEDICARE: CHEROTICH PICOTY LEITICH OTR/L

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	117281	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1770972572	OTHER		SNF

General Provider Information

NPI Number	:	1417412982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEROTICH PICOTY LEITICH OTR/L

Provider Business Mailing Address
First Line	:	7021 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7021 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4243
Country	:	US
Telephone Number	:	817-332-7003
Fax Number	:

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

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	02/08/2019

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