MEDICARE: DR. KATHLEEN LILLIAN SERFAS OTD,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	2000155183	MO
2	225X00000X	Occupational Therapist	056.008701	IL

General Provider Information

NPI Number	:	1821393968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN LILLIAN SERFAS OTD,OTR/L

Provider Business Mailing Address
First Line	:	5305 FOX CRST
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-5739
Country	:	US
Telephone Number	:	573-424-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3437 CAROLINE ST
Second Line	:	AHP, ROOM 2020
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1111
Country	:	US
Telephone Number	:	314-977-8582
Fax Number	:

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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