Healthcare Provider Details

I. General information

NPI: 1851546220
Provider Name (Legal Business Name): DANA FERN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 MADISON AVE 2ND FL.
NEW YORK NY
10017-6307
US

IV. Provider business mailing address

320 E 90TH ST #1C
NEW YORK NY
10128-4217
US

V. Phone/Fax

Practice location:
  • Phone: 212-751-9147
  • Fax: 212-980-0073
Mailing address:
  • Phone: 212-828-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010257
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: