MEDICARE: CHERYL ANN LABELLA 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	225XP0200X	Pediatric Occupational Therapist	002113-1	NY

General Provider Information

NPI Number	:	1215165725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ANN LABELLA OTR

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	NY
Zip	:	12787-0326
Country	:	US
Telephone Number	:	845-292-8169
Fax Number	:	845-292-6868

Provider Business Practice Location Address
First Line	:	817 DAHLIA ROAD
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	NY
Zip	:	12787-0326
Country	:	US
Telephone Number	:	845-292-8169
Fax Number	:	845-292-6868

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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