MEDICARE: MR. MARK DRUMMOND KURTZ OTRL

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	OT003748	GA

General Provider Information

NPI Number	:	1598960635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK DRUMMOND KURTZ OTRL

Provider Business Mailing Address
First Line	:	418 S STREET
Second Line	:
City	:	PINE MOUNTAIN VALLEY
State	:	GA
Zip	:	31823
Country	:	US
Telephone Number	:	706-628-7692
Fax Number	:	706-655-5661

Provider Business Practice Location Address
First Line	:	6135 ROOSEVELT HIGHWAY
Second Line	:
City	:	WARM SPRINGS
State	:	GA
Zip	:	31830-1000
Country	:	US
Telephone Number	:	706-655-5636
Fax Number	:	706-655-5661

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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