Healthcare Provider Details

I. General information

NPI: 1245544816
Provider Name (Legal Business Name): PADMAJA MOHAN KOTHEKAR M.SC. OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS PADMAJA S DINGANKAR

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5128 30TH AVE #4D
WOODSIDE NY
11377-7953
US

IV. Provider business mailing address

5128 30TH AVE #4D
WOODSIDE NY
11377-7953
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-8356
  • Fax: 718-545-8356
Mailing address:
  • Phone: 718-545-8356
  • Fax: 718-545-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007476-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: