MEDICARE: MANISH PATEL OTRL

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	OC-006841L	PA
2	225XH1200X	Hand Occupational Therapist	OC-006841L	PA
3	225XN1300X	Neurorehabilitation Occupational Therapist	OC-006481L	PA

General Provider Information

NPI Number	:	1508905944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH PATEL OTRL

Provider Business Mailing Address
First Line	:	133 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2717
Country	:	US
Telephone Number	:	215-455-5370
Fax Number	:	215-455-5374

Provider Business Practice Location Address
First Line	:	3251 CEDAR ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4514
Country	:	US
Telephone Number	:	215-427-2242
Fax Number	:	215-427-2433

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/25/2016

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Directions to “ MANISH PATEL OTRL” Practice Location

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