MEDICARE: MRS. MARY KATHERINE VOLPONE 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	225X00000X	Occupational Therapist	OC009274	PA
2	225X00000X	Occupational Therapist	46TR00356700	NJ

General Provider Information

NPI Number	:	1710102488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHERINE VOLPONE OTR

Provider Business Mailing Address
First Line	:	171 SHIRE DR
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-1064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 BYBERRY RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3012
Country	:	US
Telephone Number	:	215-962-4936
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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