MEDICARE: JENNIFER L OCCKIAL PT

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	225100000X	Physical Therapist	012404	OH

General Provider Information

NPI Number	:	1912132374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L OCCKIAL PT

Provider Business Mailing Address
First Line	:	5325 TODD DR
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2368
Country	:	US
Telephone Number	:	440-417-2412
Fax Number	:	216-896-0825

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR
Second Line	:	SUITE 10
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1566
Country	:	US
Telephone Number	:	216-896-0824
Fax Number	:	216-896-0825

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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Directions to “ JENNIFER L OCCKIAL PT” Practice Location

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