Healthcare Provider Details

I. General information

NPI: 1295988004
Provider Name (Legal Business Name): SHARI EVE KUBRICK MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NEWCASTLE AVE
PLAINVIEW NY
11803-2719
US

IV. Provider business mailing address

28 NEWCASTLE AVE
PLAINVIEW NY
11803-2719
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-1457
  • Fax:
Mailing address:
  • Phone: 516-939-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0065591
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: