Healthcare Provider Details

I. General information

NPI: 1639295512
Provider Name (Legal Business Name): YAEL ROTTER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PINEHURST AVE., APT. #4J
NEW YORK NY
10033
US

IV. Provider business mailing address

65 WINDING WAY
WEST ORANGE NJ
07052-3821
US

V. Phone/Fax

Practice location:
  • Phone: 646-210-4779
  • Fax:
Mailing address:
  • Phone: 646-335-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0125871
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number0125871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: