MEDICARE: MISS DEVON MARIE OHLENSCHLAEGER 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

General Provider Information

NPI Number	:	1992045553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEVON MARIE OHLENSCHLAEGER PT

Provider Business Mailing Address
First Line	:	11 EAGLE ROCK AVE
Second Line	:	201
City	:	EAST HANOVER
State	:	NJ
Zip	:	07936-3167
Country	:	US
Telephone Number	:	973-887-9000
Fax Number	:	973-887-3816

Provider Business Practice Location Address
First Line	:	7408 LAKE WORTH RD
Second Line	:	SUITE 500
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2502
Country	:	US
Telephone Number	:	561-432-3693
Fax Number	:	561-432-3694

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

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	10/03/2016

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