MEDICARE: MRS. CLARICE NICOLE BECHTLE P.T.A., M.T.

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	225200000X	Physical Therapy Assistant	3798-1	NY
2	225700000X	Massage Therapist	14699	NY

General Provider Information

NPI Number	:	1790091379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARICE NICOLE BECHTLE P.T.A., M.T.

Provider Business Mailing Address
First Line	:	PO BOX 392
Second Line	:
City	:	HARRIMAN
State	:	NY
Zip	:	10926-0392
Country	:	US
Telephone Number	:	845-283-1914
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 EMMA LN
Second Line	:
City	:	HARRIMAN
State	:	NY
Zip	:	10926-3323
Country	:	US
Telephone Number	:	845-283-1914
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	07/19/2011

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