MEDICARE: MARY M HOLSTEIN LOT

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	104978	TX

General Provider Information

NPI Number	:	1477608461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M HOLSTEIN LOT

Provider Business Mailing Address
First Line	:	909 HEMLOCK TRL
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3551
Country	:	US
Telephone Number	:	817-847-8412
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 HEMLOCK TRL
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76131-3551
Country	:	US
Telephone Number	:	817-847-8412
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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