Healthcare Provider Details

I. General information

NPI: 1356814859
Provider Name (Legal Business Name): MICHELLE SCHACHNER ZIDELE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 10TH ST
BROOKLYN NY
11230-3518
US

IV. Provider business mailing address

1080 E 21ST ST
BROOKLYN NY
11210-3616
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-4040
  • Fax:
Mailing address:
  • Phone: 718-338-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number023247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: