MEDICARE: MANDY M REPICE OTRIL

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	OT12089	FL

General Provider Information

NPI Number	:	1659406122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY M REPICE OTRIL

Provider Business Mailing Address
First Line	:	7071 SUGAR MAGNOLIA CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-7833
Country	:	US
Telephone Number	:	239-598-3356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 HERITAGE TRL
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-8715
Country	:	US
Telephone Number	:	239-530-3040
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	11/10/2008

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