MEDICARE: ACCESS DESIGN

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	225XE0001X	Environmental Modification Occupational Therapist	OC-005834-L	PA

General Provider Information

NPI Number	:	1033494745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS DESIGN

Provider Business Mailing Address
First Line	:	590 GRAVITY RD
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 GRAVITY RD
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4136
Country	:	US
Telephone Number	:	570-647-8445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER BARILLO
Credential	:	OTR/L
Telephone Number	:	570-647-8445

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	10/28/2011

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Directions to “ACCESS DESIGN ” Practice Location

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