Healthcare Provider Details

I. General information

NPI: 1417114315
Provider Name (Legal Business Name): PATRICIA CHRISTINA OTOOLE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51-55 NORTH ROUTE 9W
W. HAVERSTRAW NY
10993
US

IV. Provider business mailing address

25B EDGEWATER PARK
BRONX NY
10465-3503
US

V. Phone/Fax

Practice location:
  • Phone: 845-786-4379
  • Fax:
Mailing address:
  • Phone: 917-533-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003117-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: