MEDICARE: JAMES MITCHELL 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
1	225X00000X	Occupational Therapist	0119006510	VA
2	225X00000X	Occupational Therapist	31003325A	IN
3	225X00000X	Occupational Therapist	OT-1436	ID
4	225X00000X	Occupational Therapist	056.011279	IL
5	225X00000X	Occupational Therapist	OT 60524054	WA
6	225X00000X	Occupational Therapist	082405	IA
7	225X00000X	Occupational Therapist	16888	CA

General Provider Information

NPI Number	:	1952840548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MITCHELL OTR

Provider Business Mailing Address
First Line	:	63995 THORN RD
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	63995 THORN RD
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9174
Country	:	US
Telephone Number	:	574-274-1231
Fax Number	:

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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