Healthcare Provider Details

I. General information

NPI: 1568849479
Provider Name (Legal Business Name): JOSH KOTLER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 BROADWAY, GROUND FLOOR
NEW YORK NY
10023
US

IV. Provider business mailing address

2112 BROADWAY, GROUND FLOOR
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-1750
  • Fax: 212-799-1815
Mailing address:
  • Phone: 212-799-1750
  • Fax: 212-799-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number019590-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: