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NPI Code Detail

MEDICARE: CANDACE LEOTTA THOMAS OTA

MEDICARE: CANDACE LEOTTA THOMAS 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
1224Z00000XOccupational Therapy Assistant005076-1NY

General Provider Information

NPI Number : 1609088426
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE LEOTTA THOMAS OTA
Provider Business Mailing Address
First Line : 983 ROGERS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5416
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 121 LAKE ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-2734
Country : US
Telephone Number : 718-645-6488
Fax Number : 718-645-6579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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Directions to “ CANDACE LEOTTA THOMAS OTA” Practice Location

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