Healthcare Provider Details

I. General information

NPI: 1306535612
Provider Name (Legal Business Name): ABIGAIL JOCSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NORTHERN BLVD STE 19
GREAT NECK NY
11021-4802
US

IV. Provider business mailing address

1315 146TH ST
WHITESTONE NY
11357-2433
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number027959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: