MEDICARE: RAYMOND F. PERRY ORT/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	OT 00002538	WA

General Provider Information

NPI Number	:	1083851190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND F. PERRY ORT/L

Provider Business Mailing Address
First Line	:	5410 W SHORE RD
Second Line	:
City	:	ANACORTES
State	:	WA
Zip	:	98221-9013
Country	:	US
Telephone Number	:	360-661-5468
Fax Number	:	360-679-6646

Provider Business Practice Location Address
First Line	:	950 SE REGATTA DR # 101
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-5451
Country	:	US
Telephone Number	:	360-679-1039
Fax Number	:	360-679-6646

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

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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