MEDICARE: PAULA SANDOVAL 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	OT11209	FL

General Provider Information

NPI Number	:	1851435226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA SANDOVAL OTR,L

Provider Business Mailing Address
First Line	:	691 EVERGLADES BLVD N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-4936
Country	:	US
Telephone Number	:	305-796-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3368 WOODS EDGE CIR
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3437
Country	:	US
Telephone Number	:	239-390-2032
Fax Number	:

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/08/2007

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