MEDICARE: FAITH UY MSOT, 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	225XP0019X	Physical Rehabilitation Occupational Therapist	23596	CA
2	225X00000X	Occupational Therapist	23596	CA

General Provider Information

NPI Number	:	1760128292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH UY MSOT, OTR/L

Provider Business Mailing Address
First Line	:	5212 E SANDWOOD ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 E SANDWOOD ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1147
Country	:	US
Telephone Number	:	562-441-7191
Fax Number	:

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

Provider Enumeration Date	:	05/08/2022
Last Update Date	:	05/08/2022

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