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General NPI Number Information
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NPI Number | 1144993338
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL THERAPY NEST PLLC
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 9508 QUEENS BLVD STE 1E
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City | REGO PARK
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State | NY
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Zip | 11374-1151
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Country | US
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Telephone | 718-275-2669
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Fax |
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Provider Business Mailing Address
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Address Line | 14765 HOOVER AVE
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City | JAMAICA
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State | NY
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Zip | 11435-2139
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Country | US
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Telephone | 718-612-5634
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Fax | 718-275-2686
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Authorized Official
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Title or Position | DIRECTOR
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Name | MIKHAIL ILYASOV
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Credential | OTR/L
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Telephone | 718-612-5634
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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 |
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License Number State |
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