Healthcare Provider Details

I. General information

NPI: 1376818252
Provider Name (Legal Business Name): AVELYN ESPARRA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FAIRFIELD ST
STATEN ISLAND NY
10308-1823
US

IV. Provider business mailing address

15 FAIRFIELD ST
STATEN ISLAND NY
10308-1823
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-9800
  • Fax: 718-356-8712
Mailing address:
  • Phone: 718-984-9800
  • Fax: 718-356-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number013731-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: