MEDICARE: MRS. BRENDA CARDONE VAN SALISBURY OTR/L

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	OT9703	FL

General Provider Information

NPI Number	:	1750347431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA CARDONE VAN SALISBURY OTR/L

Provider Business Mailing Address
First Line	:	3545 MASSINI AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-2412
Country	:	US
Telephone Number	:	941-423-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 MASSINI AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-2412
Country	:	US
Telephone Number	:	941-423-0190
Fax Number	:

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	08/15/2011

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