MEDICARE: GLORIA S VIGNEAULT O.T.

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	OT 2717	FL

General Provider Information

NPI Number	:	1972837946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA S VIGNEAULT O.T.

Provider Business Mailing Address
First Line	:	715 HIBISCUS LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-2034
Country	:	US
Telephone Number	:	772-234-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 HIBISCUS LN
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-2034
Country	:	US
Telephone Number	:	772-234-8879
Fax Number	:

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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