MEDICARE: TRAVIS WILTROUT OCCUPATIONAL THERAPI

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	15016	NC
2	225X00000X	Occupational Therapist	46TR01127100	NJ

General Provider Information

NPI Number	:	1437889755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS WILTROUT OCCUPATIONAL THERAPI

Provider Business Mailing Address
First Line	:	3525 QUAKERBRIDGE RD STE 6000
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1266
Country	:	US
Telephone Number	:	609-890-9195
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 QUAKERBRIDGE RD STE 6000
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1266
Country	:	US
Telephone Number	:	609-890-9195
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/19/2023

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