MEDICARE: MRS. DEBORAH ANGBO C.O.T.A.

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	002092-1	NY

General Provider Information

NPI Number	:	1396954814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH ANGBO C.O.T.A.

Provider Business Mailing Address
First Line	:	444 NOSTRAND AVE
Second Line	:	1ST. FL.
City	:	BROOKLYN
State	:	NY
Zip	:	11216-1717
Country	:	US
Telephone Number	:	347-715-3430
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 5TH AVE
Second Line	:	SUITE 5115
City	:	NEW YORK
State	:	NY
Zip	:	10118-0110
Country	:	US
Telephone Number	:	866-696-8773
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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