MEDICARE: MR. BRIAN JOSEPH BITTNER 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	OC006527L	PA

General Provider Information

NPI Number	:	1306064977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JOSEPH BITTNER OTRL

Provider Business Mailing Address
First Line	:	3638 CANBY DR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2008
Country	:	US
Telephone Number	:	215-612-9463
Fax Number	:	215-612-9463

Provider Business Practice Location Address
First Line	:	3638 CANBY DR
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2008
Country	:	US
Telephone Number	:	215-612-9463
Fax Number	:	215-612-9463

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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