MEDICARE: DR. SHERI RAE GENOVESE O.T.D.

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	8656	CA

General Provider Information

NPI Number	:	1396970729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERI RAE GENOVESE O.T.D.

Provider Business Mailing Address
First Line	:	16166 CAYENNE RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3707
Country	:	US
Telephone Number	:	619-838-7460
Fax Number	:	858-385-1444

Provider Business Practice Location Address
First Line	:	1615 S RANCHO SANTA FE RD
Second Line	:	SUITE A
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-5194
Country	:	US
Telephone Number	:	619-838-7460
Fax Number	:	858-385-1444

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	03/07/2016

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