MEDICARE: THERESA A SLYNGSTAD OT

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	P63079	NY

General Provider Information

NPI Number	:	1629247333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA A SLYNGSTAD OT

Provider Business Mailing Address
First Line	:	529 GROSVENOR RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-3341
Country	:	US
Telephone Number	:	716-250-6500
Fax Number	:	716-250-4177

Provider Business Practice Location Address
First Line	:	720 EAST AVE
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14607-2192
Country	:	US
Telephone Number	:	585-263-2850
Fax Number	:	585-263-2885

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	10/15/2012

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