Healthcare Provider Details

I. General information

NPI: 1679948681
Provider Name (Legal Business Name): NAKISHA L HENRY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CARVER LOOP APT 19B
BRONX NY
10475-2955
US

IV. Provider business mailing address

140 CARVER LOOP APT 19B
BRONX NY
10475-2955
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-5530
  • Fax:
Mailing address:
  • Phone: 716-816-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: