MEDICARE: TRISHA CESARETTI MS/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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5201007458	OTHER	MI	OCCUPATIONAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1932606860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA CESARETTI MS/OTR/L

Provider Business Mailing Address
First Line	:	1485 HOLTON RD
Second Line	:
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445-1446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 MITZI ST
Second Line	:
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445-3232
Country	:	US
Telephone Number	:	231-206-2191
Fax Number	:

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

Provider Enumeration Date	:	04/08/2018
Last Update Date	:	04/08/2018

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