MEDICARE: EILEEN FRANCES CENTUOLO OTRL

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	0119002993	VA

General Provider Information

NPI Number	:	1740313832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN FRANCES CENTUOLO OTRL

Provider Business Mailing Address
First Line	:	2140 BELLEVUE RD
Second Line	:
City	:	HALIFAX
State	:	VA
Zip	:	24558-2672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5539 HIGHWAY FORTY SEVEN
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-3727
Country	:	US
Telephone Number	:	434-372-4063
Fax Number	:	434-372-4162

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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