Healthcare Provider Details

I. General information

NPI: 1447327069
Provider Name (Legal Business Name): RONALD CHRISTOPHER SNAGG OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14343 226TH ST
LAURELTON NY
11413-3531
US

IV. Provider business mailing address

14343 226 STREET
LAURELTON NY
11413
US

V. Phone/Fax

Practice location:
  • Phone: 917-517-4932
  • Fax:
Mailing address:
  • Phone: 917-517-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0107961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: