MEDICARE: SIENA GWANDURE

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	225XN1300X	Neurorehabilitation Occupational Therapist	057002938	IL

General Provider Information

NPI Number	:	1114395902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIENA GWANDURE

Provider Business Mailing Address
First Line	:	7710 JAMESTOWN NORTH DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1942
Country	:	US
Telephone Number	:	847-845-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 JAMESTOWN NORTH DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1942
Country	:	US
Telephone Number	:	847-845-7704
Fax Number	:

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

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	09/10/2015

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Directions to “ SIENA GWANDURE ” Practice Location

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