MEDICARE: MISS DAWN MARIE EINFELDT OTA6429

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	224Z00000X	Occupational Therapy Assistant	OTA6429	FL

General Provider Information

NPI Number	:	1528308863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DAWN MARIE EINFELDT OTA6429

Provider Business Mailing Address
First Line	:	1430 ISLAND DR S
Second Line	:	APT/SUITE
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-3714
Country	:	US
Telephone Number	:	727-560-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 ISLAND DR S
Second Line	:	APT/SUITE
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-3714
Country	:	US
Telephone Number	:	727-560-4624
Fax Number	:

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

Provider Enumeration Date	:	02/24/2013
Last Update Date	:	02/24/2013

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