MEDICARE: MISS PATRICIA ALYSE MUSALL OTD, 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	31006713A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31006713A	OTHER	IN	OCCUPATIONAL THERAPY LICENSE

General Provider Information

NPI Number	:	1083193650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATRICIA ALYSE MUSALL OTD, OTR/L

Provider Business Mailing Address
First Line	:	902 PROVIDENT DR STE C
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3379
Country	:	US
Telephone Number	:	574-376-2316
Fax Number	:	574-306-2208

Provider Business Practice Location Address
First Line	:	902 PROVIDENT DR STE C
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3379
Country	:	US
Telephone Number	:	574-376-2316
Fax Number	:	574-306-2208

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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