MEDICARE: BRITTANY N LEAR OTA

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	224Z00000X	Occupational Therapy Assistant	32001461A	IN

General Provider Information

NPI Number	:	1548401458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY N LEAR OTA

Provider Business Mailing Address
First Line	:	3400 STOCKER DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-6142
Country	:	US
Telephone Number	:	812-424-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 STOCKER DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-6142
Country	:	US
Telephone Number	:	812-424-8100
Fax Number	:

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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