MEDICARE: MISS PRITI R. PATEL 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	OT003859	GA

General Provider Information

NPI Number	:	1952377137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PRITI R. PATEL OTR/L

Provider Business Mailing Address
First Line	:	1922 WILDCAT FALLS LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-2987
Country	:	US
Telephone Number	:	404-307-3282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 PANOLA MILL DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-2352
Country	:	US
Telephone Number	:	770-981-4927
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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