MEDICARE: CHILDREN'S MILESTONE 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1568513166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MILESTONE INC

Provider Business Mailing Address
First Line	:	2872 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1669
Country	:	US
Telephone Number	:	260-497-0838
Fax Number	:	260-497-9088

Provider Business Practice Location Address
First Line	:	2872 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1669
Country	:	US
Telephone Number	:	260-497-0838
Fax Number	:	260-497-9088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABIGAIL BUENCONSEJO
Credential	:	OTR
Telephone Number	:	260-497-0838

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/05/2008

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