MEDICARE: SUCCESS IN MOTION THERAPY LLC

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

General Provider Information

NPI Number	:	1043505472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESS IN MOTION THERAPY LLC

Provider Business Mailing Address
First Line	:	2637 27TH AVE S
Second Line	:	SUITE 212
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-250-5097
Fax Number	:	612-823-0208

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S
Second Line	:	SUITE 212
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-250-5097
Fax Number	:	612-823-0208

Authorized Official
Title or Position	:	OWNER
Name	:	NAOMI SIEGAL
Credential	:	OTR/L
Telephone Number	:	612-250-5097

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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