MEDICARE: CHIAKI CYR 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	OT 2057	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336224641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIAKI CYR OTR L

Provider Business Mailing Address
First Line	:	3143 APPALOOSA BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7853
Country	:	US
Telephone Number	:	321-271-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 W EAU GALLIE BLVD
Second Line	:	SUITE 208
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7213
Country	:	US
Telephone Number	:	321-255-6627
Fax Number	:	321-259-8779

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/09/2007

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