MEDICARE: TEJAL KOLWANKAR

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	15486	FL

General Provider Information

NPI Number	:	1124424049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJAL KOLWANKAR

Provider Business Mailing Address
First Line	:	198 115TH AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-2802
Country	:	US
Telephone Number	:	412-980-2784
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 115TH AVE NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-2802
Country	:	US
Telephone Number	:	412-980-2784
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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Directions to “ TEJAL KOLWANKAR ” Practice Location

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