Healthcare Provider Details

I. General information

NPI: 1275953317
Provider Name (Legal Business Name): APPLE BLOSSOM OCCUPATIONAL THERAPY SERVICES PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E 33RD ST APT 15D
NEW YORK NY
10016-5338
US

IV. Provider business mailing address

210 E 86TH ST SUITE 202
NEW YORK NY
10028-3003
US

V. Phone/Fax

Practice location:
  • Phone: 347-210-2963
  • Fax: 917-508-4856
Mailing address:
  • Phone: 347-210-2963
  • Fax: 917-508-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number010190
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number010190
License Number StateNY

VIII. Authorized Official

Name: MS. VAISHALI PRAKASH KHANDARE
Title or Position: DIRECTOR
Credential: OTR/L
Phone: 347-210-2963