MEDICARE: MRS. KIRSTEN ERIN PATTERSON MA 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	225XP0200X	Pediatric Occupational Therapist	11786	FL
2	225X00000X	Occupational Therapist	007137	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4620006	OTHER	OH	UNITED HEALTHCARE GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083701072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIRSTEN ERIN PATTERSON MA OTR/L

Provider Business Mailing Address
First Line	:	8006 LAKEPOINTE DR
Second Line	:	BLDG #1
City	:	PLANTATION
State	:	FL
Zip	:	33322-5726
Country	:	US
Telephone Number	:	954-370-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 OLD TROY PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-5740
Country	:	US
Telephone Number	:	937-233-1230
Fax Number	:	937-236-8930

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2008

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