MEDICARE: MS. COURTNEY REBECCA MIDDLETON OTR/L, CHT, CLT

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	008582-1	NY
2	225XE1200X	Ergonomics Occupational Therapist	008582-1	NY
3	225XH1200X	Hand Occupational Therapist	008582-1	NY

General Provider Information

NPI Number	:	1275860041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COURTNEY REBECCA MIDDLETON OTR/L, CHT, CLT

Provider Business Mailing Address
First Line	:	21 WINDING RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3818
Country	:	US
Telephone Number	:	585-746-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 STATE ROUTE 332
Second Line	:
City	:	FARMINGTON
State	:	NY
Zip	:	14425-1077
Country	:	US
Telephone Number	:	585-924-3642
Fax Number	:

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

Provider Enumeration Date	:	11/15/2009
Last Update Date	:	11/15/2009

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