MEDICARE: CAROLYN MARTIN MUSICH

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	OT14379	FL
2	225XP0200X	Pediatric Occupational Therapist	0119000753	VA
3	225XP0200X	Pediatric Occupational Therapist	OT14379	FL

General Provider Information

NPI Number	:	1316226640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MARTIN MUSICH

Provider Business Mailing Address
First Line	:	6201 SPRING OAK CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-1561
Country	:	US
Telephone Number	:	813-265-3545
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 SPRING OAK CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-1561
Country	:	US
Telephone Number	:	813-265-3545
Fax Number	:

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

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	02/06/2012

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Directions to “ CAROLYN MARTIN MUSICH ” Practice Location

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