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NPI Code Detail

MEDICARE: MRS. RAQUEL BRODY MS, OTR/L

MEDICARE: MRS. RAQUEL BRODY MS, 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
1225XP0200XPediatric Occupational Therapist0101171NY

General Provider Information

NPI Number : 1245548106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RAQUEL BRODY MS, OTR/L
Provider Business Mailing Address
First Line : 3555 223RD ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-2236
Country : US
Telephone Number : 917-502-1231
Fax Number :
Provider Business Practice Location Address
First Line : 3555 223RD ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-2236
Country : US
Telephone Number : 917-502-1231
Fax Number :
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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