MEDICARE: MS. BERYL LARA MILSTEIN 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	115588	TX

General Provider Information

NPI Number	:	1427480391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERYL LARA MILSTEIN OTR/L

Provider Business Mailing Address
First Line	:	571 STATION RD
Second Line	:
City	:	ROCK TAVERN
State	:	NY
Zip	:	12575-5546
Country	:	US
Telephone Number	:	845-781-6051
Fax Number	:

Provider Business Practice Location Address
First Line	:	571 STATION RD
Second Line	:
City	:	ROCK TAVERN
State	:	NY
Zip	:	12575-5546
Country	:	US
Telephone Number	:	845-781-6051
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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