Healthcare Provider Details

I. General information

NPI: 1306375126
Provider Name (Legal Business Name): WILLIAM A DEGEORGE OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 - 38TH STREET STEP BY STEP INFANT DEVELOPMENT CENTER
BROOKLYN NY
11219
US

IV. Provider business mailing address

122 CORSON AVE
STATEN ISLAND NY
10301-2943
US

V. Phone/Fax

Practice location:
  • Phone: 718-633-6666
  • Fax:
Mailing address:
  • Phone: 718-354-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number021357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: