MEDICARE: MRS. JERYL ROBIN YAEGER OTR

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	3570-01	NY

General Provider Information

NPI Number	:	1689828972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JERYL ROBIN YAEGER OTR

Provider Business Mailing Address
First Line	:	1354 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6011
Country	:	US
Telephone Number	:	718-645-9163
Fax Number	:	718-998-4766

Provider Business Practice Location Address
First Line	:	1354 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6011
Country	:	US
Telephone Number	:	718-645-9163
Fax Number	:	718-998-4766

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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