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General NPI Number Information
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NPI Number | 1316200702
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Entity Type | Organization
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Legal Business Name | FUNTASTIC OT, P.C.
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 2016 E 35TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-4922
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Country | US
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Telephone | 917-692-3529
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Fax | 718-491-2788
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Provider Business Mailing Address
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Address Line | 2016 E 35TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-4922
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Country | US
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Telephone | 917-692-3529
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Fax | 718-491-2788
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. JESSICA D. CUTRONE
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Credential | OTR/L
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Telephone | 917-692-3529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 011124-1
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License Number State | NY
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