MEDICARE: SEEMA MORENO O.T.R/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	OT002221	GA

General Provider Information

NPI Number	:	1649223587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEEMA MORENO O.T.R/L

Provider Business Mailing Address
First Line	:	375 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1509
Country	:	US
Telephone Number	:	770-775-4622
Fax Number	:	770-775-4132

Provider Business Practice Location Address
First Line	:	375 MCDONOUGH RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1509
Country	:	US
Telephone Number	:	770-775-4622
Fax Number	:	770-775-4132

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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