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NPI Code Detail

MEDICARE: ANNE M MIX OTR/L

MEDICARE: ANNE M MIX 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
1225X00000XOccupational Therapist006854-1NY

General Provider Information

NPI Number : 1760799522
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE M MIX OTR/L
Provider Business Mailing Address
First Line : 5355 W TAFT RD
Second Line :
City : NORTH SYRACUSE
State : NY
Zip : 13212-2767
Country : US
Telephone Number : 315-218-2100
Fax Number :
Provider Business Practice Location Address
First Line : 5355 W TAFT RD
Second Line :
City : NORTH SYRACUSE
State : NY
Zip : 13212-2767
Country : US
Telephone Number : 315-218-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2010
Last Update Date : 08/31/2010

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