MEDICARE: ELEAZAR KAPUNAN OCCUPATIONAL THERAPI

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	1032	TN

General Provider Information

NPI Number	:	1134591423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEAZAR KAPUNAN OCCUPATIONAL THERAPI

Provider Business Mailing Address
First Line	:	21 SILVERCREST CV
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7862
Country	:	US
Telephone Number	:	731-394-6549
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 SILVERCREST CV
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7862
Country	:	US
Telephone Number	:	731-394-6549
Fax Number	:

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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