MEDICARE: MRS. SYLVIA JOAN SMALL-EHILEN CMT

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	174400000X	Specialist	MO1976	MD

General Provider Information

NPI Number	:	1215064027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SYLVIA JOAN SMALL-EHILEN CMT

Provider Business Mailing Address
First Line	:	2406 VIRGINIA AVE APT 103
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-3377
Country	:	US
Telephone Number	:	202-297-0224
Fax Number	:	301-773-4867

Provider Business Practice Location Address
First Line	:	4007 34TH ST
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1908
Country	:	US
Telephone Number	:	202-297-0224
Fax Number	:	301-773-4867

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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