MEDICARE: JEFFREY RIEDEL-BICKNELL OTR L

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	5697	NC

General Provider Information

NPI Number	:	1174647374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY RIEDEL-BICKNELL OTR L

Provider Business Mailing Address
First Line	:	PO BOX 691775
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-7030
Country	:	US
Telephone Number	:	704-771-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	10620 STONE BUNKER DRIVE
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-7036
Country	:	US
Telephone Number	:	704-771-0051
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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Directions to “ JEFFREY RIEDEL-BICKNELL OTR L” Practice Location

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