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NPI Code Detail

MEDICARE: MR. JASON GEORGE BERTRAND OTR

MEDICARE: MR. JASON GEORGE BERTRAND OTR
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
1225X00000XOccupational Therapist8212MA

General Provider Information

NPI Number : 1912109026
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON GEORGE BERTRAND OTR
Provider Business Mailing Address
First Line : 27 CHAMPLAIN ROAD
Second Line : P.O. BOX 220
City : STILLWATER
State : NY
Zip : 12170
Country : US
Telephone Number : 203-619-2691
Fax Number :
Provider Business Practice Location Address
First Line : 17 CHIPMAN WAY
Second Line :
City : KINGSTON
State : MA
Zip : 02364-1039
Country : US
Telephone Number : 781-336-5107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 07/08/2007

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