MEDICARE: JAESEN PETRETTA INC

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	261QR0400X	Rehabilitation Clinic/Center	OT10199	FL

General Provider Information

NPI Number	:	1487094983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAESEN PETRETTA INC

Provider Business Mailing Address
First Line	:	4281 7TH AVE SW
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE STE 158
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3867
Country	:	US
Telephone Number	:	239-839-3408
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAESEN PETRETTA
Credential	:	OTR/L
Telephone Number	:	239-839-3408

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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Directions to “JAESEN PETRETTA INC ” Practice Location

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