MEDICARE: MS. MICHELINE MCCABE OT

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	OT11673	FL

General Provider Information

NPI Number	:	1740303478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELINE MCCABE OT

Provider Business Mailing Address
First Line	:	1515 E BROWARD BLVD APT 405
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2142
Country	:	US
Telephone Number	:	561-846-9414
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 CITY VIEW DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-9120
Country	:	US
Telephone Number	:	954-661-5695
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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