=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154548501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE PAIGE KREBS O.T.R.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 SEGUINE AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10309-3721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-967-4442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 COMMUNITY CIR
-----------------------------------------------------
City | OLD BRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08857-1949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-952-5293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 008499-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------