MEDICARE: MARY LANE GARMON 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	225X00000X	Occupational Therapist	105666	TX

General Provider Information

NPI Number	:	1447207683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LANE GARMON OT

Provider Business Mailing Address
First Line	:	PO BOX 716
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-0716
Country	:	US
Telephone Number	:	817-694-3573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 OLD ANNETTA RD
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-3855
Country	:	US
Telephone Number	:	817-694-3573
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/11/2008

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