MEDICARE: EMILY BENNETT PHILLIPS MS OT R/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	OT005609	GA

General Provider Information

NPI Number	:	1912242736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BENNETT PHILLIPS MS OT R/L

Provider Business Mailing Address
First Line	:	271 WRIGHTS MILL WAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-7511
Country	:	US
Telephone Number	:	404-425-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 MARTIN RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-5542
Country	:	US
Telephone Number	:	678-679-1261
Fax Number	:

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

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	10/27/2016

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