MEDICARE: GWEN EICHIN

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	224Z00000X	Occupational Therapy Assistant	005685-1	NY

General Provider Information

NPI Number	:	1154634715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN EICHIN

Provider Business Mailing Address
First Line	:	235 ODAK FARM RD
Second Line	:
City	:	MILAN
State	:	NY
Zip	:	12571-4026
Country	:	US
Telephone Number	:	518-622-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 ODAK FARM RD
Second Line	:
City	:	MILAN
State	:	NY
Zip	:	12571-4026
Country	:	US
Telephone Number	:	518-622-8382
Fax Number	:

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

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	07/23/2010

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Directions to “ GWEN EICHIN ” Practice Location

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