MEDICARE: SHARON VINCUILLA MAOT, CPDT-KA

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
2	225XM0800X	Mental Health Occupational Therapist

General Provider Information

NPI Number	:	1043739469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON VINCUILLA MAOT, CPDT-KA

Provider Business Mailing Address
First Line	:	12948 MOORPARK ST APT 4
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-5032
Country	:	US
Telephone Number	:	323-774-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	12948 MOORPARK ST APT 4
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-5032
Country	:	US
Telephone Number	:	323-774-4547
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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