MEDICARE: MS. ELISE HENRY 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	006762-1	NY
2	225X00000X	Occupational Therapist	TR 01568	NJ

General Provider Information

NPI Number	:	1437302700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISE HENRY OTR/L

Provider Business Mailing Address
First Line	:	127 BROAD AVE
Second Line	:
City	:	LEONIA
State	:	NJ
Zip	:	07605-2030
Country	:	US
Telephone Number	:	718-601-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 HENRY HUDSON PKWY W
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10463-4701
Country	:	US
Telephone Number	:	718-601-7400
Fax Number	:

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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