MEDICARE: HEATHER THERESA BEDNARZ MS, 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	07262492	PA
2	225X00000X	Occupational Therapist	OC010617	PA

General Provider Information

NPI Number	:	1588808612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER THERESA BEDNARZ MS, OTR/L

Provider Business Mailing Address
First Line	:	1157 NEW ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1721
Country	:	US
Telephone Number	:	570-677-4093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 NEW ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1721
Country	:	US
Telephone Number	:	706-774-0935
Fax Number	:

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

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	02/18/2020

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