MEDICARE: CELESTIA R DRYSDALE OTR

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	31000084A	IN

General Provider Information

NPI Number	:	1295964351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTIA R DRYSDALE OTR

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT
Second Line	:	SUITE 201
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5002
Country	:	US
Telephone Number	:	502-412-5847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 LYNDON FARM CT
Second Line	:	SUITE 201
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5002
Country	:	US
Telephone Number	:	502-412-5847
Fax Number	:

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

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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