MEDICARE: ROBERT E IRWIN 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	225XH1200X	Hand Occupational Therapist	OC001327L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	852850	OTHER	PA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1851354963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E IRWIN OTR/L

Provider Business Mailing Address
First Line	:	6998 CRIDER RD
Second Line	:	SUITE 200
City	:	MARS
State	:	PA
Zip	:	16046-2390
Country	:	US
Telephone Number	:	724-778-3311
Fax Number	:	724-779-3313

Provider Business Practice Location Address
First Line	:	6998 CRIDER RD
Second Line	:	SUITE 200
City	:	MARS
State	:	PA
Zip	:	16046-2390
Country	:	US
Telephone Number	:	724-778-3311
Fax Number	:	724-779-3313

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	06/29/2012

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