MEDICARE: MS. ALLISON LEA RUDDER OTRL

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	KYR2611	KY
2	225X00000X	Occupational Therapist	OT 13346	FL

General Provider Information

NPI Number	:	1437136694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON LEA RUDDER OTRL

Provider Business Mailing Address
First Line	:	530 47TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-1854
Country	:	US
Telephone Number	:	772-774-8954
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 47TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-1854
Country	:	US
Telephone Number	:	772-774-8954
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	05/26/2009

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