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General NPI Number Information
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NPI Number | 1083967525
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Entity Type | Organization
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Legal Business Name | CAMACHO'S PURPOSEFUL OCCUPATIONAL THERAPY, P.C.
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 1121 ASHLEY DR
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City | VALLEY STREAM
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State | NY
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Zip | 11580-2431
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Country | US
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Telephone | 917-679-9546
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 ASHLEY DR
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City | VALLEY STREAM
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State | NY
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Zip | 11580-2431
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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 | TRACY CAMACHO
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Credential | OTR/L
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Telephone | 917-679-9546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 016784
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License Number State | NY
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