Healthcare Provider Details

I. General information

NPI: 1215247903
Provider Name (Legal Business Name): PATRICIA HENRY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SOUNDVIEW CRST
MANHASSET NY
11030-3615
US

IV. Provider business mailing address

26 SOUNDVIEW CRST
MANHASSET NY
11030-3615
US

V. Phone/Fax

Practice location:
  • Phone: 516-317-0536
  • Fax:
Mailing address:
  • Phone: 516-317-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4023-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: