MEDICARE: ALLISON COST 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	016069-1	NY

General Provider Information

NPI Number	:	1013223486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON COST MS, OTR-L

Provider Business Mailing Address
First Line	:	100 MANHATTAN AVE
Second Line	:	APT 714
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5240
Country	:	US
Telephone Number	:	210-686-5703
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MANHATTAN AVE
Second Line	:	APT 714
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5240
Country	:	US
Telephone Number	:	210-686-5703
Fax Number	:

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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