MEDICARE: MAYA SINAI MA, 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	225XP0200X	Pediatric Occupational Therapist	14294	CA

General Provider Information

NPI Number	:	1891202610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA SINAI MA, OTR/L

Provider Business Mailing Address
First Line	:	2134 S BENTLEY AVE APT 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 WELLESLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3629
Country	:	US
Telephone Number	:	310-386-3484
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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