MEDICARE: MRS. TAVI MCLEOD

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	OT9096	FL

General Provider Information

NPI Number	:	1962573402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAVI MCLEOD

Provider Business Mailing Address
First Line	:	575 SARINA TER SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-4042
Country	:	US
Telephone Number	:	772-696-4883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 WATERFORD DR
Second Line	:	ALLIANCE CARE CLINIC
City	:	VERO BEACH
State	:	FL
Zip	:	32966-8043
Country	:	US
Telephone Number	:	772-564-0484
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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