MEDICARE: MARK NOEL VILLARAMA SAN JOSE 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	0119006077	VA
2	225X00000X	Occupational Therapist	06222	MD

General Provider Information

NPI Number	:	1649557547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK NOEL VILLARAMA SAN JOSE OTR/L

Provider Business Mailing Address
First Line	:	7 CARNEGIE PLZ
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1000
Country	:	US
Telephone Number	:	877-407-3422
Fax Number	:	877-407-4329

Provider Business Practice Location Address
First Line	:	1833 W PLAZA DR
Second Line	:	FOX REHAB VIRGINIA REGIONAL OFFICE
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	877-407-3422
Fax Number	:

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

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	09/18/2013

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