MEDICARE: EMILY NICOLE PIKE MOT, 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	2012036144	MO
2	225X00000X	Occupational Therapist	056.009184	IL

General Provider Information

NPI Number	:	1881947158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NICOLE PIKE MOT, OTR/L

Provider Business Mailing Address
First Line	:	4809 KAREN LN
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-2687
Country	:	US
Telephone Number	:	618-830-7154
Fax Number	:

Provider Business Practice Location Address
First Line	:	634 N MAIN ST STE 1
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-3746
Country	:	US
Telephone Number	:	618-690-0068
Fax Number	:

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

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	09/14/2016

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