=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699175166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTA MALGORZATA SIKORSKA MSOT OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2014
-----------------------------------------------------
Last Update Date | 09/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2817 HIGHLAND AVE S APT 2A
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-253-4440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 HIGHLAND AVE S APT 2A
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-253-4440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3786
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------