MEDICARE: LINDA MARIE DECKERT 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	005101	OH

General Provider Information

NPI Number	:	1770789505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA MARIE DECKERT OTR

Provider Business Mailing Address
First Line	:	6366 LAKEARBOR DR
Second Line	:
City	:	INDEPENDENCE
State	:	KY
Zip	:	41051-8302
Country	:	US
Telephone Number	:	859-359-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6566 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4410
Country	:	US
Telephone Number	:	513-574-5400
Fax Number	:	513-574-6222

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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