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NPI Code Detail

MEDICARE: MARCELLA D BRAXTON MOT

MEDICARE:   MARCELLA D BRAXTON  MOT
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 TherapistOT11745FL

General Provider Information

NPI Number : 1568607059
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLA D BRAXTON MOT
Provider Business Mailing Address
First Line : 2222 SULLIVAN TRL
Second Line :
City : EASTON
State : PA
Zip : 18040-7958
Country : US
Telephone Number : 800-944-9782
Fax Number : 610-438-2024
Provider Business Practice Location Address
First Line : 6895 BELFORT OAKS PL
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-6242
Country : US
Telephone Number : 904-296-2384
Fax Number : 904-296-2915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2008
Last Update Date : 12/11/2008

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Directions to “ MARCELLA D BRAXTON MOT” Practice Location

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