Healthcare Provider Details

I. General information

NPI: 1316261753
Provider Name (Legal Business Name): NEW YORK THERAPY RESOURCES OT, PT, & ST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 MYRTLE AVE
BROOKLYN NY
11205-2536
US

IV. Provider business mailing address

474 MYRTLE AVE PO BOX 050208
BROOKLYN NY
11205-2536
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-0066
  • Fax:
Mailing address:
  • Phone: 718-388-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023227
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012371
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number009993
License Number StateNY

VIII. Authorized Official

Name: DANIELLE ANGELIQUE BROWN
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 718-388-0066