MEDICARE: CLINICAL NEURODEVELOPMENT SEMINARS

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	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1063671139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL NEURODEVELOPMENT SEMINARS

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	:	PRESIDENT
Name	:	SANDRA MASAYKO
Credential	:
Telephone Number	:	215-879-2929

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/04/2008

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