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General NPI Number Information
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NPI Number | 1265320485
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Entity Type | Organization
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Legal Business Name | HOME THERAPY OT PLLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 865 PLUM TREE RD W
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City | WESTBURY
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State | NY
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Zip | 11590-6031
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Country | US
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Telephone | 516-218-1767
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Fax |
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Provider Business Mailing Address
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Address Line | 865 PLUM TREE RD W
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City | WESTBURY
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State | NY
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Zip | 11590-6031
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Country | US
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Telephone | 516-218-1767
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Fax |
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Authorized Official
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Title or Position | OWNER PROVIDER AUTHORIZED OFFICIAL
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Name | JUSTIN M. CHACKO
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Credential | OTR/L
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Telephone | 516-218-1767
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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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