MEDICARE: SHERI'S OCCUPATIONAL THERAPY SERVICES

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	2251P0200X	Pediatric Physical Therapist	41403	CA
2	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	OT 8656	CA
3	225XP0200X	Pediatric Occupational Therapist	OT8656	CA

General Provider Information

NPI Number	:	1912367723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERI'S OCCUPATIONAL THERAPY SERVICES

Provider Business Mailing Address
First Line	:	16166 CAYENNE RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3707
Country	:	US
Telephone Number	:	619-838-7460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 S RANCHO SANTA FE RD
Second Line	:	SUITE A
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-5194
Country	:	US
Telephone Number	:	619-838-7460
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHERI RAE GENOVESE
Credential	:	OTD, OTR/L
Telephone Number	:	619-838-7460

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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