Healthcare Provider Details

I. General information

NPI: 1619207479
Provider Name (Legal Business Name): FUNCTIONAL OCCUPATIONAL THERAPY SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 JAMAICA AVE
WOODHAVEN NY
11421-2268
US

IV. Provider business mailing address

8384 116TH ST SUITE
RICHMOND HILL NY
11418-3470
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-4070
  • Fax: 718-441-4027
Mailing address:
  • Phone: 718-578-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number015493-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number015493-1
License Number StateNY

VIII. Authorized Official

Name: MS. POLINA STARR
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 718-578-9786