MEDICARE: MR. EDER CHARLES MSOTR/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	224ZE0001X	Environmental Modification Occupational Therapy Assistant	46TR00515500	NJ
2	225000000X	Orthotic Fitter	46TR00515500	NJ
3	225X00000X	Occupational Therapist	46TR00515500	NJ
4	225XH1200X	Hand Occupational Therapist	46TR00515500	NJ
5	225XP0019X	Physical Rehabilitation Occupational Therapist	46TR00515500	NJ
6	225XR0403X	Driving and Community Mobility Occupational Therapist	46TR00515500	NJ

General Provider Information

NPI Number	:	1689078313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDER CHARLES MSOTR/L

Provider Business Mailing Address
First Line	:	56 CLINTON PL
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-1219
Country	:	US
Telephone Number	:	908-868-9109
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 CLINTON PL
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-1219
Country	:	US
Telephone Number	:	908-868-9109
Fax Number	:

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

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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