MEDICARE: MS. ELIZABETH A GEORGE OTRL

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	OT12690	FL
2	225X00000X	Occupational Therapist	OC010147	PA
3	225X00000X	Occupational Therapist	05860	MD
4	225X00000X	Occupational Therapist	0119004544	VA

General Provider Information

NPI Number	:	1114122298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH A GEORGE OTRL

Provider Business Mailing Address
First Line	:	2354 WALNUT BOTTOM RD
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-9374
Country	:	US
Telephone Number	:	717-856-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	24011 MADACA LN APT 6-204
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2806
Country	:	US
Telephone Number	:	717-856-5552
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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