MEDICARE: WALTER TRENSCHEL, PH.D.

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	103G00000X	Clinical Neuropsychologist	PY4569	FL
2	103TC0700X	Clinical Psychologist	PY4569	FL

General Provider Information

NPI Number	:	1215118294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER TRENSCHEL, PH.D.

Provider Business Mailing Address
First Line	:	5505 N OCEAN BLVD
Second Line	:	LEXINGTON 101
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7086
Country	:	US
Telephone Number	:	561-706-3426
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 N OCEAN BLVD
Second Line	:	LEXINGTON 101
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7086
Country	:	US
Telephone Number	:	561-706-3426
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ELISE DILEONARDO
Credential	:
Telephone Number	:	954-321-1980

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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