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General NPI Number Information
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NPI Number | 1194032623
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Entity Type | Individual
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Provider Name | SIPPORAH REBECCA TRACER OT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 150 BENNETT AVE 7D
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City | NEW YORK
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State | NY
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Zip | 10040-3811
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Country | US
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Telephone | 718-885-6617
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Fax |
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Provider Business Mailing Address
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Address Line | 150 BENNETT AVE 7D
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City | NY
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State | NY
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Zip | 10040
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Country | US
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Telephone | 718-885-6617
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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 | P77587
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License Number State | NY
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