MEDICARE: EMILY SOUTHMAN

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	007698	OH

General Provider Information

NPI Number	:	1902158561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SOUTHMAN

Provider Business Mailing Address
First Line	:	5509 NORTH GLEN ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248
Country	:	US
Telephone Number	:	513-288-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	5509 N GLEN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-4252
Country	:	US
Telephone Number	:	513-288-0557
Fax Number	:

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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Directions to “ EMILY SOUTHMAN ” Practice Location

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