MEDICARE: BLAISE ANTHONY OBRITZ OT

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	OT21971	FL

General Provider Information

NPI Number	:	1922044007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAISE ANTHONY OBRITZ OT

Provider Business Mailing Address
First Line	:	86 GROVE DR STE 100
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-7215
Country	:	US
Telephone Number	:	412-720-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 CORPORATE DR
Second Line	:	STE 100
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-7005
Country	:	US
Telephone Number	:	412-369-7735
Fax Number	:	412-369-7704

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/23/2021

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