MEDICARE: JENNIFER A BARILLO OT

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	OC005834L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	843516	OTHER	PA	MANAGED PHYSICIAN NETWORK
2	843516	OTHER	NY	MANAGED PHYSICIAN NETWORK

General Provider Information

NPI Number	:	1316930829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A BARILLO OT

Provider Business Mailing Address
First Line	:	590 GRAVITY RD
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4136
Country	:	US
Telephone Number	:	570-647-8445
Fax Number	:	570-647-8445

Provider Business Practice Location Address
First Line	:	590 GRAVITY ROAD
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4136
Country	:	US
Telephone Number	:	570-647-8445
Fax Number	:	570-647-8445

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/22/2011

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