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General NPI Number Information
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NPI Number | 1356657506
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Entity Type | Individual
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Provider Name | ROSE MARIE CASTILLO LARDIZABAL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 5809 32ND AVE APT# 1
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City | WOODSIDE
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State | NY
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Zip | 11377-2017
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Country | US
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Telephone | 718-440-9639
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Fax | 718-440-9639
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Provider Business Mailing Address
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Address Line | 5809 32ND AVE APT# 1
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City | WOODSIDE
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State | NY
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Zip | 11377-2017
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Country | US
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Telephone | 718-440-9639
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Fax | 718-440-9639
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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 | 012138-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0007929
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License Number State | FL
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