Healthcare Provider Details

I. General information

NPI: 1992950661
Provider Name (Legal Business Name): MONICA LAUREN NATHAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2008
Last Update Date: 11/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 PROSPECT AVE APT 204
BROOKLYN NY
11218-1124
US

IV. Provider business mailing address

1115 PROSPECT AVE APT 204
BROOKLYN NY
11218-1124
US

V. Phone/Fax

Practice location:
  • Phone: 917-804-3716
  • Fax: 718-768-2474
Mailing address:
  • Phone: 917-804-3716
  • Fax: 718-768-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number012801-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: