MEDICARE: JENNIFER GRICAR OTR

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	OC006104L	PA

General Provider Information

NPI Number	:	1619927167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GRICAR OTR

Provider Business Mailing Address
First Line	:	1310 LINCOLN WAY
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 LINCOLN WAY
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2419
Country	:	US
Telephone Number	:	412-678-7545
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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