MEDICARE: EDMOT PROFESSIONAL SERVICES

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

General Provider Information

NPI Number	:	1326878208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMOT PROFESSIONAL SERVICES

Provider Business Mailing Address
First Line	:	1537 68TH ST APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-6322
Country	:	US
Telephone Number	:	646-401-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 OCEAN AVE # 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4705
Country	:	US
Telephone Number	:	646-401-1861
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MAYA AFRUZI
Credential	:	OT
Telephone Number	:	646-401-1861

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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Directions to “EDMOT PROFESSIONAL SERVICES ” Practice Location

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