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General NPI Number Information
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NPI Number | 1467966820
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Entity Type | Individual
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Provider Name | LEAH MATAT OTA
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Gender | Female
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 71-44 YELLOWSTONE BLVD REHAB DEPARTMENT
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City | FOREST HILSS
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State | NY
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Zip | 11375
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Country | US
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Telephone | 718-544-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 65-10 99 ST APT 5E
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 646-348-0654
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 006635-1
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License Number State | NY
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