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General NPI Number Information
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NPI Number | 1003218801
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE OCCUPATIONAL THERAPIST SERVICES PC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 22811 LINDEN BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1847
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Country | US
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Telephone | 917-573-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 22811 LINDEN BLVD
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City | CAMBRIA HEIGHTS
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State | NY
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Zip | 11411-1847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | DR. LILLIAN E HAMER
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Credential | OTD
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Telephone | 917-573-3808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 012047
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License Number State | NY
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