MEDICARE: TRAVIS GERALD MCLAUGHLIN OTR/L

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

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

General Provider Information

NPI Number	:	1316418007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS GERALD MCLAUGHLIN OTR/L

Provider Business Mailing Address
First Line	:	236 W 135TH ST APT 2A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2805
Country	:	US
Telephone Number	:	917-858-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-2507
Country	:	US
Telephone Number	:	718-617-5688
Fax Number	:

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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