MEDICARE: ASHOK SADASIVAIAH O.T.

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	225XH1200X	Hand Occupational Therapist	16438	CA

General Provider Information

NPI Number	:	1255782074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHOK SADASIVAIAH O.T.

Provider Business Mailing Address
First Line	:	117 S HELBERTA AVE UNIT 4
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-7206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 WILSHIRE BLVD STE 310
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5683
Country	:	US
Telephone Number	:	310-829-3320
Fax Number	:

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	07/07/2016

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