=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841847217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN LORRAINE SELL COT/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2019
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SENSORY SOLUTIONS LLC 22 SARASOTA CENTER BLVD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-377-9361
-----------------------------------------------------
Fax | 800-370-8553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3631 CAROL LN
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-914-6036
-----------------------------------------------------
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 | 10313
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------