MEDICARE: MRS. SHEILA MARIE CRAVEN OTR/L

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	225XP0200X	Pediatric Occupational Therapist	572	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	572	OTHER	NE	DEPARTMENT OF HEALTH AND HUMAN SERVICES
2	1012739	OTHER	NE	NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC.

General Provider Information

NPI Number	:	1285001289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEILA MARIE CRAVEN OTR/L

Provider Business Mailing Address
First Line	:	512 W PHILLIP AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-5208
Country	:	US
Telephone Number	:	402-644-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 E SYCAMORE AVE
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-0842
Country	:	US
Telephone Number	:	402-841-2681
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	08/25/2015

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