MEDICARE: SANDRA MASAYKO

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	OC000719L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003080912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MASAYKO

Provider Business Mailing Address
First Line	:	6407 OVERBROOK AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19151-2414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6407 OVERBROOK AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19151-2414
Country	:	US
Telephone Number	:	215-879-2929
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	05/19/2008

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Directions to “ SANDRA MASAYKO ” Practice Location

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