MEDICARE: MRS. ELIZABETH ANNA ZIMMERMAN M.S.O.T.R.

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 4110	CA

General Provider Information

NPI Number	:	1477654275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANNA ZIMMERMAN M.S.O.T.R.

Provider Business Mailing Address
First Line	:	3657 BLUEBERRY HILL DR
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8885
Country	:	US
Telephone Number	:	530-677-5492
Fax Number	:	530-677-5492

Provider Business Practice Location Address
First Line	:	3657 BLUEBERRY HILL DR
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8885
Country	:	US
Telephone Number	:	530-677-5492
Fax Number	:	530-677-5492

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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