MEDICARE: BRENDA MARIE GEORGE 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	225XP0200X	Pediatric Occupational Therapist	OT0173	OH

General Provider Information

NPI Number	:	1629009394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE GEORGE OTR/L

Provider Business Mailing Address
First Line	:	7380 LITHOPOLIS RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9732
Country	:	US
Telephone Number	:	740-687-5949
Fax Number	:	749-687-5949

Provider Business Practice Location Address
First Line	:	7380 LITHOPOLIS RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9732
Country	:	US
Telephone Number	:	740-687-5949
Fax Number	:	749-687-5949

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/02/2010

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