Healthcare Provider Details

I. General information

NPI: 1871418574
Provider Name (Legal Business Name): FAVIOLA LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N 9TH AVE APT BS3
MOUNT VERNON NY
10550-1916
US

IV. Provider business mailing address

7 N 9TH AVE APT BS3
MOUNT VERNON NY
10550-1916
US

V. Phone/Fax

Practice location:
  • Phone: 631-215-8729
  • Fax:
Mailing address:
  • Phone: 631-215-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030960-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: