MEDICARE: LINDA SEDORCHUK 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	225X00000X	Occupational Therapist	OT 881	CA

General Provider Information

NPI Number	:	1306066840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA SEDORCHUK OTR

Provider Business Mailing Address
First Line	:	18246 DOS PICOS PARK RD
Second Line	:
City	:	RAMONA
State	:	CA
Zip	:	92065-7346
Country	:	US
Telephone Number	:	760-788-6718
Fax Number	:

Provider Business Practice Location Address
First Line	:	5740 LAKE MURRAY BLVD
Second Line	:	OAKDALE HEIGHTS
City	:	LA MESA
State	:	CA
Zip	:	91942-2217
Country	:	US
Telephone Number	:	619-461-9014
Fax Number	:	619-461-7381

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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