MEDICARE: MARLA HIGHFIELD SEYMOUR OTR

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	225XP0200X	Pediatric Occupational Therapist	6172	NC

General Provider Information

NPI Number	:	1942405311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA HIGHFIELD SEYMOUR OTR

Provider Business Mailing Address
First Line	:	1324 THORNY VINE CT
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-1641
Country	:	US
Telephone Number	:	919-453-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 HAWORTH DR
Second Line	:	SUITE 222
City	:	RALEIGH
State	:	NC
Zip	:	27609-7238
Country	:	US
Telephone Number	:	919-662-8340
Fax Number	:	919-832-6405

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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