MEDICARE: MISS ADI SHIMONI OTR/L

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	5685	NC

General Provider Information

NPI Number	:	1043305261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ADI SHIMONI OTR/L

Provider Business Mailing Address
First Line	:	203 TARTAN TRL
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-7523
Country	:	US
Telephone Number	:	919-951-9251
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-423-5538

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/07/2009

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