MEDICARE: MISS TATIANNA SLEDD MSOTR

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	31004245A	IN

General Provider Information

NPI Number	:	1750591038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TATIANNA SLEDD MSOTR

Provider Business Mailing Address
First Line	:	1038 SPRINGWATER CIR
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7797
Country	:	US
Telephone Number	:	317-345-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEADOW LAKE DR
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1837
Country	:	US
Telephone Number	:	317-834-1791
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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