MEDICARE: MRS. KRISTINE M TAIT MOT, 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	OC009454	PA

General Provider Information

NPI Number	:	1033346283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE M TAIT MOT, OTR/L

Provider Business Mailing Address
First Line	:	890 BEAVER GRADE RD
Second Line	:
City	:	MOON TWP
State	:	PA
Zip	:	15108-2653
Country	:	US
Telephone Number	:	412-474-3566
Fax Number	:	412-474-3575

Provider Business Practice Location Address
First Line	:	890 BEAVER GRADE RD
Second Line	:
City	:	MOON TWP
State	:	PA
Zip	:	15108-2653
Country	:	US
Telephone Number	:	412-474-3566
Fax Number	:	412-474-3575

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

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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