MEDICARE: NANCY HOEDL MSOTR/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	2005018058	MO
2	225XP0200X	Pediatric Occupational Therapist	2005018058	MO

General Provider Information

NPI Number	:	1043501430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY HOEDL MSOTR/L

Provider Business Mailing Address
First Line	:	6563 S RIVERBRIDGE RD
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3114
Country	:	US
Telephone Number	:	417-234-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	6563 S RIVERBRIDGE RD
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3114
Country	:	US
Telephone Number	:	417-234-2969
Fax Number	:

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

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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