MEDICARE: STEPHANIE ESGRO

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	:	1912309428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ESGRO

Provider Business Mailing Address
First Line	:	116 W WINTHROP ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-1775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3426 CONRAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1600
Country	:	US
Telephone Number	:	570-575-5573
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	12/18/2014

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Directions to “ STEPHANIE ESGRO ” Practice Location

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