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NPI Code Detail

MEDICARE: MANDI PACKER O.T.

MEDICARE: MANDI PACKER O.T.
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
1225X00000XOccupational Therapist5099OH

General Provider Information

NPI Number : 1518985423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDI PACKER O.T.
Provider Business Mailing Address
First Line : 104 SYCAMORE WAY
Second Line :
City : THORNVILLE
State : OH
Zip : 43076-8001
Country : US
Telephone Number : 740-246-5723
Fax Number :
Provider Business Practice Location Address
First Line : 8745 BLACKBIRD LN
Second Line :
City : THORNVILLE
State : OH
Zip : 43076-9515
Country : US
Telephone Number : 740-246-5483
Fax Number : 740-246-6480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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Directions to “ MANDI PACKER O.T.” Practice Location

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