MEDICARE: MS. EVELYN REDA MED, OTR

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	2203 OT	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT0056	OTHER	MA	BC/BS OF MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972537165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVELYN REDA MED, OTR

Provider Business Mailing Address
First Line	:	22 HITCHING POST RD
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-1155
Country	:	US
Telephone Number	:	413-549-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 UNIVERSITY DR
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2232
Country	:	US
Telephone Number	:	413-256-8185
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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