Healthcare Provider Details

I. General information

NPI: 1669365383
Provider Name (Legal Business Name): EDWARD STUART GUZMAN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE
FLUSHING NY
11354-4277
US

IV. Provider business mailing address

262 W 122ND ST APT 2A
NEW YORK NY
10027-5474
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-1288
  • Fax:
Mailing address:
  • Phone: 760-585-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: