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General NPI Number Information
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NPI Number | 1568774958
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Entity Type | Individual
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Provider Name | LYNDA BROCK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 162 W 72ND ST 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10023-3300
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Country | US
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Telephone | 212-721-5220
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Fax | 212-982-9816
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Provider Business Mailing Address
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Address Line | 201 ENGERT AVE APT 2L
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City | BROOKLYN
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State | NY
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Zip | 11222-5127
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Country | US
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Telephone |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 015023-1
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License Number State | NY
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