MEDICARE: ENCOMPASS PELVIC HEALTH PLLC

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

General Provider Information

NPI Number	:	1811703440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCOMPASS PELVIC HEALTH PLLC

Provider Business Mailing Address
First Line	:	218 BENNETT POND RD
Second Line	:
City	:	CANTERBURY
State	:	CT
Zip	:	06331-1528
Country	:	US
Telephone Number	:	207-463-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 S ANGUILLA RD
Second Line	:
City	:	PAWCATUCK
State	:	CT
Zip	:	06379-1447
Country	:	US
Telephone Number	:	207-463-6361
Fax Number	:

Authorized Official
Title or Position	:	OWNER, OCCUPATIONAL THERAPIST
Name	:	SUSAN YEBRA
Credential	:	OTD
Telephone Number	:	207-463-6361

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/10/2024

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