MEDICARE: MS. SHERYL GOLDMAN OTA

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	224Z00000X	Occupational Therapy Assistant	1095	CA

General Provider Information

NPI Number	:	1134521289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERYL GOLDMAN OTA

Provider Business Mailing Address
First Line	:	1034 20TH ST
Second Line	:	APT B
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4541
Country	:	US
Telephone Number	:	310-741-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 20TH ST
Second Line	:	APT B
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4541
Country	:	US
Telephone Number	:	310-741-1969
Fax Number	:

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

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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