MEDICARE: EDNA SIVORI 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	225XP0200X	Pediatric Occupational Therapist	117506	TX
2	225X00000X	Occupational Therapist	117506	TX

General Provider Information

NPI Number	:	1578914172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA SIVORI OTR/L

Provider Business Mailing Address
First Line	:	6305 WALEBRIDGE LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78739-1571
Country	:	US
Telephone Number	:	512-826-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	6305 WALEBRIDGE LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78739-1571
Country	:	US
Telephone Number	:	512-826-3225
Fax Number	:

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

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	11/12/2024

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Directions to “ EDNA SIVORI OTR/L” Practice Location

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