MEDICARE: KHATUNA OZBETELASHVILI

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	104100000X	Social Worker	SW133960	PA

General Provider Information

NPI Number	:	1427535814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHATUNA OZBETELASHVILI

Provider Business Mailing Address
First Line	:	11600 CAROLINE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 CAROLINE RD FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-2110
Country	:	US
Telephone Number	:	267-307-2437
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “ KHATUNA OZBETELASHVILI ” Practice Location

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