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General NPI Number Information
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NPI Number | 1396970729
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Entity Type | Individual
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Provider Name | SHERI RAE GENOVESE O.T.D.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1615 S RANCHO SANTA FE RD SUITE A
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City | SAN MARCOS
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State | CA
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Zip | 92078-5194
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Country | US
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Telephone | 619-838-7460
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Fax | 858-385-1444
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Provider Business Mailing Address
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Address Line | 16166 CAYENNE RIDGE RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-3707
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Country | US
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Telephone | 619-838-7460
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Fax | 858-385-1444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 8656
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License Number State | CA
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