MEDICARE: MRS. JACLYN A SANTANGELO MOT

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	WV001014	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1714909	OTHER	WV	BLUE CROSS BLUE SHIELD
2	7104487	OTHER	WV	AETNA
3	1062861	OTHER	WV	WORKERS COMP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	311504453	OTHER	WV	CIGNA
6	311504453	OTHER	WV	ACORDIA

General Provider Information

NPI Number	:	1205998986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACLYN A SANTANGELO MOT

Provider Business Mailing Address
First Line	:	301 PLANTATION DR
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9063
Country	:	US
Telephone Number	:	304-757-3240
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 TEAYS VALLEY RD
Second Line	:	SUITE 100
City	:	HURRICANE
State	:	WV
Zip	:	25526-9645
Country	:	US
Telephone Number	:	304-757-2500
Fax Number	:	304-757-2586

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. JACLYN A SANTANGELO MOT” Practice Location

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