=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811656580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH RENEE SCARBROUGH COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2021
-----------------------------------------------------
Last Update Date | 12/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3270 SE 58TH AVE STE C, BLDG 2
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-869-4113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 SW 46TH CT APT 2002
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-6286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-869-4113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA17109
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------