Healthcare Provider Details

I. General information

NPI: 1023375748
Provider Name (Legal Business Name): SONG HUI RIMASSA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 RAYMOND PL
STATEN ISLAND NY
10310-2635
US

IV. Provider business mailing address

4200 MANOR RD
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7439
  • Fax:
Mailing address:
  • Phone: 718-698-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011988-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: