MEDICARE: MRS. ALICIA MARIE FRY OTR/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	225X00000X	Occupational Therapist	OC009240	PA

General Provider Information

NPI Number	:	1720279391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA MARIE FRY OTR/L

Provider Business Mailing Address
First Line	:	4025 MOUNT PISGAH RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17406-8260
Country	:	US
Telephone Number	:	717-244-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 FOLKEMER CIR
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-1755
Country	:	US
Telephone Number	:	717-767-5404
Fax Number	:

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

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

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