MEDICARE: NATALIA CHERNYSHOVA MSOTR/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	225XG0600X	Gerontology Occupational Therapist

General Provider Information

NPI Number	:	1831455336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA CHERNYSHOVA MSOTR/L

Provider Business Mailing Address
First Line	:	301 BYBERRY RD
Second Line	:	B15
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1947
Country	:	US
Telephone Number	:	267-262-2279
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 BYBERRY RD
Second Line	:	B15
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1947
Country	:	US
Telephone Number	:	267-262-2279
Fax Number	:

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

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/09/2012

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