MEDICARE: MRS. CARON ERICA SCHABORT 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	OT002443	GA

General Provider Information

NPI Number	:	1952729485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARON ERICA SCHABORT OTR/L

Provider Business Mailing Address
First Line	:	5 ETOWAH DR SE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-8467
Country	:	US
Telephone Number	:	770-546-4310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 CHULIO RD SE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-4084
Country	:	US
Telephone Number	:	706-235-1132
Fax Number	:

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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