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General NPI Number Information
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NPI Number | 1487921144
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Entity Type | Organization
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Legal Business Name | JUMPSTART OCCUPATIONAL THERAPY PC
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 703 EMERSON ST
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City | WOODMERE
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State | NY
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Zip | 11598-2836
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Country | US
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Telephone | 917-741-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 703 EMERSON ST
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City | WOODMERE
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State | NY
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Zip | 11598-2836
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Country | US
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Telephone | 917-741-3659
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. LISA FELDMAN
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Credential | MS OTR/L
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Telephone | 917-741-3659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 011987
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License Number State | NY
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