MEDICARE: MRS. NATASHA RUTHERFORD

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	63 014611	NY

General Provider Information

NPI Number	:	1760920227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATASHA RUTHERFORD

Provider Business Mailing Address
First Line	:	26 TAYLOR RD
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-4507
Country	:	US
Telephone Number	:	917-225-4202
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 CENTRAL AVE
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-5004
Country	:	US
Telephone Number	:	917-215-4202
Fax Number	:

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

Provider Enumeration Date	:	02/05/2017
Last Update Date	:	02/05/2017

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