MEDICARE: MR. JOHN CASTRO OTA

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	224Z00000X	Occupational Therapy Assistant	007003-1	NY

General Provider Information

NPI Number	:	1225346182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CASTRO OTA

Provider Business Mailing Address
First Line	:	429 BRONX PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-2436
Country	:	US
Telephone Number	:	646-261-7463
Fax Number	:	347-398-0206

Provider Business Practice Location Address
First Line	:	429 BRONX PARK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-2436
Country	:	US
Telephone Number	:	646-261-7463
Fax Number	:	347-398-0206

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

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/14/2010

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