MEDICARE: BEAVERCREEK HAND AND BODY THERAPY

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	332B00000X	Durable Medical Equipment & Medical Supplies		OH
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1134107568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERCREEK HAND AND BODY THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 140
Second Line	:
City	:	ALPHA
State	:	OH
Zip	:	45301-0140
Country	:	US
Telephone Number	:	937-478-4210
Fax Number	:	866-272-1218

Provider Business Practice Location Address
First Line	:	1525 XENIA AVE
Second Line	:
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1123
Country	:	US
Telephone Number	:	937-478-4210
Fax Number	:	866-272-1218

Authorized Official
Title or Position	:	OWNER
Name	:	CINDY A. GRUHOT
Credential	:	OTR/L,CHT,CLT
Telephone Number	:	937-478-4210

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	11/09/2022

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