MEDICARE: ROBIN MERCADO OTD

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	25823	CA

General Provider Information

NPI Number	:	1477320356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN MERCADO OTD

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	951-335-9825
Fax Number	:	812-590-8333

Provider Business Practice Location Address
First Line	:	24671 MONROE AVE STE 101
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-2527
Country	:	US
Telephone Number	:	951-677-4105
Fax Number	:	951-677-4106

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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