MEDICARE: MR. THOMAS MICHAEL STITTS MOT

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	6775	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6775	OTHER	OH	OT LICENSE

General Provider Information

NPI Number	:	1861763724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MICHAEL STITTS MOT

Provider Business Mailing Address
First Line	:	8309 MANOR GATE WAY
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5971
Country	:	US
Telephone Number	:	216-392-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	8309 MANOR GATE WAY
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5971
Country	:	US
Telephone Number	:	216-392-7434
Fax Number	:

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

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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