MEDICARE: CARLENE TRAVIS

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	224ZR0403X	Driving and Community Mobility Occupational Therapy Assistant	2022252916891	CA

General Provider Information

NPI Number	:	1104537406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLENE TRAVIS

Provider Business Mailing Address
First Line	:	3400 COTTAGE WAY STE G2
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-1474
Country	:	US
Telephone Number	:	888-204-5762
Fax Number	:

Provider Business Practice Location Address
First Line	:	9219 RAINBOW CREEK WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4814
Country	:	US
Telephone Number	:	916-289-0659
Fax Number	:

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

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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Directions to “ CARLENE TRAVIS ” Practice Location

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