MEDICARE: MS. SUSAN JILL GRETZ MSOT

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	225XP0200X	Pediatric Occupational Therapist	OC004509L	PA

General Provider Information

NPI Number	:	1316492556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN JILL GRETZ MSOT

Provider Business Mailing Address
First Line	:	505 MAYFIELD AVE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-5211
Country	:	US
Telephone Number	:	610-701-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 MAYFIELD AVE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-5211
Country	:	US
Telephone Number	:	610-701-4258
Fax Number	:

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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