Healthcare Provider Details

I. General information

NPI: 1316212715
Provider Name (Legal Business Name): JEANINE BECKER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 MARATHON PKWY
LITTLE NECK NY
11362-2042
US

IV. Provider business mailing address

10 STUART PL
MANHASSET NY
11030-2620
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-8060
  • Fax:
Mailing address:
  • Phone: 516-627-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008374-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: