Healthcare Provider Details

I. General information

NPI: 1972628402
Provider Name (Legal Business Name): MICHELE PETRAKIS OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE PIRONTI

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KISCO AVE
MOUNT KISCO NY
10549-1415
US

IV. Provider business mailing address

74 MAPLES RD
MIDDLETOWN NY
10940-6724
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-8720
  • Fax: 914-242-8762
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: