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General NPI Number Information
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NPI Number | 1639446354
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF EDUCATION
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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 | 281 9TH AVE
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City | NEW YORK
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State | NY
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Zip | 10001-5701
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Country | US
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Telephone | 212-563-4886
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Fax |
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Provider Business Mailing Address
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Address Line | 11032 64TH RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-1418
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Country | US
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Telephone | 646-436-6777
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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. JUNELANDE COUTARD
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Credential | OTR/L
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Telephone | 646-436-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0147411
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License Number State | NY
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