MEDICARE: GEORGIA MAE PITTS

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	112850	TX

General Provider Information

NPI Number	:	1871736306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA MAE PITTS

Provider Business Mailing Address
First Line	:	702 FALDO CV
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-4332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7271 WURZBACH RD STE 127
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4718
Country	:	US
Telephone Number	:	210-563-7783
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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Directions to “ GEORGIA MAE PITTS ” Practice Location

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