MEDICARE: MS. MARGARET (PEG) ANN BLEDSOE 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
2	225X00000X	Occupational Therapist	OT:1757	CA

General Provider Information

NPI Number	:	1740621598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARET (PEG) ANN BLEDSOE OTR/L

Provider Business Mailing Address
First Line	:	1276 GABRIEL CT
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-6821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 GABRIEL CT
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-6821
Country	:	US
Telephone Number	:	510-435-6246
Fax Number	:

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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