MEDICARE: MRS. SANDRA PURVIS O.T.R./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	OC004044L	PA

General Provider Information

NPI Number	:	1194911131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA PURVIS O.T.R./L.

Provider Business Mailing Address
First Line	:	63 W LANCASTER AVE
Second Line	:	SUITE 6
City	:	ARDMORE
State	:	PA
Zip	:	19003-1413
Country	:	US
Telephone Number	:	610-649-1400
Fax Number	:	610-649-1715

Provider Business Practice Location Address
First Line	:	63 W LANCASTER AVE
Second Line	:	SUITE 6
City	:	ARDMORE
State	:	PA
Zip	:	19003-1413
Country	:	US
Telephone Number	:	610-649-1400
Fax Number	:	610-649-1715

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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