MEDICARE: SARA MCGRUDER 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	225X00000X	Occupational Therapist	9485	CA

General Provider Information

NPI Number	:	1578872966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MCGRUDER OTR/L

Provider Business Mailing Address
First Line	:	249 E OCEAN BLVD
Second Line	:	#440
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4849
Country	:	US
Telephone Number	:	888-808-7838
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 E OCEAN BLVD
Second Line	:	#440
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4849
Country	:	US
Telephone Number	:	888-808-7838
Fax Number	:

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

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	10/01/2010

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