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General NPI Number Information
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NPI Number | 1174917462
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Entity Type | Organization
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Legal Business Name | CHIMENE TIROL OT PC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 1298 ROCKLAND AVE SUITE 1H
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4936
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Country | US
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Telephone | 609-598-0668
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Fax |
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Provider Business Mailing Address
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Address Line | 1298 ROCKLAND AVE SUITE 1H
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4936
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Country | US
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Telephone | 609-598-0668
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIMENE TIROL
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Credential |
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Telephone | 609-598-0668
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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 | 011946
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License Number State | NY
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