MEDICARE: MS. SUSAN LENN OCCUPATIONAL THERAPI

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	KYR2829	KY
2	225X00000X	Occupational Therapist	31003543A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285799296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN LENN OCCUPATIONAL THERAPI

Provider Business Mailing Address
First Line	:	323 S CYPRESS ST
Second Line	:
City	:	BOONVILLE
State	:	IN
Zip	:	47601-1739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 HIDDEN LAKE PT
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-4455
Country	:	US
Telephone Number	:	270-316-1499
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	05/01/2009

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