MEDICARE: ROSALIND MARCIA MISHKIN OTR

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	OC001007L	PA

General Provider Information

NPI Number	:	1538389143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIND MARCIA MISHKIN OTR

Provider Business Mailing Address
First Line	:	1576 WILLOW POND DR
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-5796
Country	:	US
Telephone Number	:	215-369-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1615
Country	:	US
Telephone Number	:	215-787-9367
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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