MEDICARE: CARRIE RUDMAN O.T.

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	5201003478	MI

General Provider Information

NPI Number	:	1659746915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE RUDMAN O.T.

Provider Business Mailing Address
First Line	:	3381 HIDDEN OAKS LN
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 ORCHARD LAKE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2382
Country	:	US
Telephone Number	:	248-757-2330
Fax Number	:

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

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	12/11/2015

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