MEDICARE: SANDRA PRANTL OTRL, CST-D

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-00925	OH

General Provider Information

NPI Number	:	1124230867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA PRANTL OTRL, CST-D

Provider Business Mailing Address
First Line	:	5137 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2237
Country	:	US
Telephone Number	:	513-351-0775
Fax Number	:	513-351-2515

Provider Business Practice Location Address
First Line	:	5137 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2237
Country	:	US
Telephone Number	:	513-351-0775
Fax Number	:	513-351-2515

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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