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NPI Code Detail

MEDICARE: BEATRICE JARVIS OTRL

MEDICARE: BEATRICE JARVIS 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
1225X00000XOccupational Therapist001276GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
352703833OTHERGABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1790786275
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEATRICE JARVIS OTRL
Provider Business Mailing Address
First Line : 304 E 6TH AVE
Second Line :
City : ROME
State : GA
Zip : 30161-6000
Country : US
Telephone Number : 706-378-9044
Fax Number : 706-378-9046
Provider Business Practice Location Address
First Line : 304 E 6TH AVE
Second Line :
City : ROME
State : GA
Zip : 30161-6000
Country : US
Telephone Number : 706-378-9044
Fax Number : 706-378-9046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/09/2007

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1043361348 — KIMBERLY H REYNOLDS PT
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Directions to “ BEATRICE JARVIS OTRL” Practice Location

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