MEDICARE: MS. SARAH RUALO 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	06178	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06178	OTHER	MD	STATE OF MARYLAND OT LICENSE

General Provider Information

NPI Number	:	1962824979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH RUALO OTR/L

Provider Business Mailing Address
First Line	:	6808 DUCKETTS LN
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 BENSON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1035
Country	:	US
Telephone Number	:	410-646-6536
Fax Number	:

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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