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General NPI Number Information
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NPI Number | 1073822722
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Entity Type | Organization
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Legal Business Name | PADMORE OCCUPATIONAL THERAPY, P.C.
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 61 W GRAND ST STE 0C
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City | MOUNT VERNON
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State | NY
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Zip | 10552-2133
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Country | US
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Telephone | 718-612-6188
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Fax | 866-352-6711
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Provider Business Mailing Address
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Address Line | 61 W GRAND ST STE 0C
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City | MOUNT VERNON
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State | NY
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Zip | 10552-2133
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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 | PRESIDENT
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Name | JACKIE PADMORE
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Credential | OTR/L
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Telephone | 718-612-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 010811
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 010811
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 0108011
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License Number State | NY
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