MEDICARE: MS. SHEILA FAYE LEFEVRA

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	224Z00000X	Occupational Therapy Assistant	212322	TX
2	224Z00000X	Occupational Therapy Assistant	32001698A	IN

General Provider Information

NPI Number	:	1548626740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEILA FAYE LEFEVRA

Provider Business Mailing Address
First Line	:	2515 HUBERTUS AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 HUBERTUS AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-3722
Country	:	US
Telephone Number	:	260-413-7118
Fax Number	:

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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