MEDICARE: PTOT PROFESSIONALS INC

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	0462	SD
2	225100000X	Physical Therapist	0440	SD
3	225100000X	Physical Therapist	0512	SD

General Provider Information

NPI Number	:	1235121500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PTOT PROFESSIONALS INC

Provider Business Mailing Address
First Line	:	2001 7TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4661
Country	:	US
Telephone Number	:	605-716-6474
Fax Number	:	605-716-6484

Provider Business Practice Location Address
First Line	:	2001 7TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4661
Country	:	US
Telephone Number	:	605-716-6474
Fax Number	:	605-716-6484

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KATHLEEN A BOYLE
Credential	:	OT
Telephone Number	:	605-716-6474

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	06/10/2008

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Directions to “PTOT PROFESSIONALS INC ” Practice Location

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