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General NPI Number Information
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NPI Number | 1639073299
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Entity Type | Organization
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Legal Business Name | FUN THERAPY OT PLLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 314 NELSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3408
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Country | US
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Telephone | 347-465-7180
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Fax |
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Provider Business Mailing Address
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Address Line | 236 LYNDALE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5542
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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 | OCCUPATIONAL THERAPIST
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Name | NICOLE DIBLASI
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Credential | MOT
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Telephone | 347-465-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | NULL
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