Healthcare Provider Details

I. General information

NPI: 1043529233
Provider Name (Legal Business Name): GILA J. KURTZ OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14134 70TH AVE
FLUSHING NY
11367-1928
US

IV. Provider business mailing address

14134 70TH AVE
FLUSHING NY
11367-1928
US

V. Phone/Fax

Practice location:
  • Phone: 347-302-8832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number004962-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number004962-01
License Number StateNY

VIII. Authorized Official

Name: GILA J. KURTZ
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 347-302-8832