MEDICARE: MS. SALLY ELAINE THIMM OTR

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	OT4376	FL

General Provider Information

NPI Number	:	1144356320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY ELAINE THIMM OTR

Provider Business Mailing Address
First Line	:	5865 HARRISON RD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-6835
Country	:	US
Telephone Number	:	941-228-3562
Fax Number	:	941-492-2020

Provider Business Practice Location Address
First Line	:	425 COMMERCIAL CT
Second Line	:	#100
City	:	VENICE
State	:	FL
Zip	:	34292-1642
Country	:	US
Telephone Number	:	941-228-3562
Fax Number	:	941-492-2020

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	03/09/2009

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