Healthcare Provider Details

I. General information

NPI: 1720644404
Provider Name (Legal Business Name): K.B. OCCUPATIONAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 OYSTER BAY RD
EAST NORWICH NY
11732-1051
US

IV. Provider business mailing address

264 N RICHMOND AVE
MASSAPEQUA NY
11758-3229
US

V. Phone/Fax

Practice location:
  • Phone: 516-581-6499
  • Fax:
Mailing address:
  • Phone: 516-581-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BISHOP
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS OTR/L
Phone: 516-581-6499