MEDICARE: LESLIE MCGIVNEY 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	016100	NY

General Provider Information

NPI Number	:	1205141603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MCGIVNEY OTR/L

Provider Business Mailing Address
First Line	:	230 BROOK AVE APT 16
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4122
Country	:	US
Telephone Number	:	646-418-2913
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-2045
Country	:	US
Telephone Number	:	212-288-1450
Fax Number	:

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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