MEDICARE: NATASHA LEE WHEELOCK

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1831604230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA LEE WHEELOCK

Provider Business Mailing Address
First Line	:	1070 BRIAR RIDGE RD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1712
Country	:	US
Telephone Number	:	954-850-8690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 BRIAR RIDGE RD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1712
Country	:	US
Telephone Number	:	954-850-8690
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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