MEDICARE: AMY WATSON-GRACE MOT, OTR/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	OT.004643	OH

General Provider Information

NPI Number	:	1962555359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WATSON-GRACE MOT, OTR/L

Provider Business Mailing Address
First Line	:	2033 BELLFLOWER CT
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8346
Country	:	US
Telephone Number	:	614-361-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 BELLFLOWER CT
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8346
Country	:	US
Telephone Number	:	614-361-2785
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/18/2014

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