MEDICARE: GRETCHEN QUAVE O'REAR 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	3582	AL

General Provider Information

NPI Number	:	1578802096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN QUAVE O'REAR OT

Provider Business Mailing Address
First Line	:	3140 CAHABA HEIGHTS RD
Second Line	:	SUITE 102
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-969-8080
Fax Number	:	205-969-4884

Provider Business Practice Location Address
First Line	:	3140 CAHABA HEIGHTS RD
Second Line	:	SUITE 102
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-969-8080
Fax Number	:	205-969-4884

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	07/09/2015

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