MEDICARE: MR. CLEMENTE OCAMPO AQUINO JR. OTR/L

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	0004282087	WA

General Provider Information

NPI Number	:	1578755666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLEMENTE OCAMPO AQUINO JR. OTR/L

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	426-473-5611
Fax Number	:	423-339-8329

Provider Business Practice Location Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	426-473-5611
Fax Number	:	423-339-8329

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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