Healthcare Provider Details

I. General information

NPI: 1174386007
Provider Name (Legal Business Name): VICTORIA CAGLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PRESIDENT ST STE 1E
BROOKLYN NY
11215-1491
US

IV. Provider business mailing address

681 W 193RD ST APT 3C
NEW YORK NY
10040-2735
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-0088
  • Fax:
Mailing address:
  • Phone: 504-655-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number028851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: