MEDICARE: SUSAN L GARRETT OT

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	OC001830L	PA

General Provider Information

NPI Number	:	1134373343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L GARRETT OT

Provider Business Mailing Address
First Line	:	401 MINGO RD
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 W BEAU ST
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-4663
Country	:	US
Telephone Number	:	724-228-5656
Fax Number	:

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

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	11/14/2008

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