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NPI Code Detail

MEDICARE: AMY COSTELLO OTR/L

MEDICARE: AMY COSTELLO 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
1225X00000XOccupational TherapistOC006009LPA

General Provider Information

NPI Number : 1053884486
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY COSTELLO OTR/L
Provider Business Mailing Address
First Line : 147 LAFAYETTE MANOR RD
Second Line :
City : UNIONTOWN
State : PA
Zip : 15401-8900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 147 LAFAYETTE MANOR RD
Second Line :
City : UNIONTOWN
State : PA
Zip : 15401-8900
Country : US
Telephone Number : 724-430-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2019
Last Update Date : 01/14/2019

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