MEDICARE: MR. PHILIPPE ROBERT DEBROUX OTRL

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	OT9696	FL

General Provider Information

NPI Number	:	1225077621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIPPE ROBERT DEBROUX OTRL

Provider Business Mailing Address
First Line	:	1120 MCFARLAND ST
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-3527
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 27TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-3202
Country	:	US
Telephone Number	:	727-251-8903
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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