MEDICARE: CHELSEA SHALOM MS, 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	019010	NY

General Provider Information

NPI Number	:	1770983058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA SHALOM MS, OTR/L

Provider Business Mailing Address
First Line	:	1493 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6404
Country	:	US
Telephone Number	:	646-206-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1493 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6404
Country	:	US
Telephone Number	:	646-206-8391
Fax Number	:

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

Provider Enumeration Date	:	08/24/2014
Last Update Date	:	08/24/2014

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