MEDICARE: SHARMA JO PRIVETT

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 14356	FL
2	225X00000X	Occupational Therapist	804	SC
3	225X00000X	Occupational Therapist	31005385A	IN

General Provider Information

NPI Number	:	1326387226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARMA JO PRIVETT

Provider Business Mailing Address
First Line	:	540 PORT MALABAR BLVD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4407
Country	:	US
Telephone Number	:	321-614-5244
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 PORT MALABAR BLVD NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4407
Country	:	US
Telephone Number	:	321-614-5244
Fax Number	:

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

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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Directions to “ SHARMA JO PRIVETT ” Practice Location

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