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General NPI Number Information
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NPI Number | 1326483751
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL THERAPY GROUP, LLP
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 688 COMMANDER AVE
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City | WEST BABYLON
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State | NY
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Zip | 11704-2302
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Country | US
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Telephone | 917-453-8417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1607
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City | WEST BABYLON
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State | NY
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Zip | 11704-0607
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Country | US
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Telephone | 917-453-8417
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MORYAM LADOTUN
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Credential |
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Telephone | 917-453-8417
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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 | 017172-1
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License Number State | NY
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