Healthcare Provider Details

I. General information

NPI: 1134364292
Provider Name (Legal Business Name): CAROL DODDS-LISS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 164TH ST
JAMAICA NY
11432-1118
US

IV. Provider business mailing address

8635 250TH ST
BELLEROSE NY
11426-2405
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-3000
  • Fax: 718-380-3214
Mailing address:
  • Phone: 718-347-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000849
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: