=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467069971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENSORY STYLE OT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2020
-----------------------------------------------------
Last Update Date | 09/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1063 NORTH AVE
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10804-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-612-0426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1063 NORTH AVE
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10804-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-612-0426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LAURIE LASHER
-----------------------------------------------------
Credential | MBA OTL
-----------------------------------------------------
Telephone | 917-612-0426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------