Healthcare Provider Details

I. General information

NPI: 1902711153
Provider Name (Legal Business Name): POORNA SREENIVAS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S FRANKLIN AVE STE 10
VALLEY STREAM NY
11580-6105
US

IV. Provider business mailing address

10 WOODED LN
ALLEN TX
75013-2955
US

V. Phone/Fax

Practice location:
  • Phone: 646-745-0854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: