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NPI Code Detail

MEDICARE: MRS. PATRICIA ANN BODINE-OXFORD M.S./C.A.S

MEDICARE: MRS. PATRICIA ANN BODINE-OXFORD M.S./C.A.S
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
1222Q00000XDevelopmental TherapistNY

General Provider Information

NPI Number : 1336742428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA ANN BODINE-OXFORD M.S./C.A.S
Provider Business Mailing Address
First Line : 6723 TOWPATH RD
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-9506
Country : US
Telephone Number : 315-425-1004
Fax Number : 315-422-4855
Provider Business Practice Location Address
First Line : 6723 TOWPATH RD
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-9506
Country : US
Telephone Number : 315-425-1004
Fax Number : 315-422-4855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2020
Last Update Date : 07/21/2022

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