=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538411319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAKES SENSE OT ST PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2012
-----------------------------------------------------
Last Update Date | 10/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91-10 146TH STREET
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-696-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 EAST 43RD STREET 24TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | MRS. LORI H. KOFFLER
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 917-696-2171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 002141
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------