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General NPI Number Information
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NPI Number | 1164798666
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Entity Type | Individual
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Provider Name | LAURA MARIE CANTWELL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 3265 93RD ST
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City | EAST ELMHURST
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State | NY
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Zip | 11369-2451
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Country | US
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Telephone | 718-899-5799
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Fax |
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Provider Business Mailing Address
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Address Line | 985 OCEANFRONT ST APT 3
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City | LONG BEACH
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State | NY
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Zip | 11561-1344
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Country | US
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Telephone | 516-770-3410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 010497
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License Number State | NY
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