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General NPI Number Information
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NPI Number | 1689991788
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Entity Type | Organization
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Legal Business Name | NY THERAAPY PLACEMENY, INC
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 162 SYMPHONY DR
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City | LAKE GROVE
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State | NY
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Zip | 11755
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Country | US
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Telephone | 516-209-7618
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Fax |
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Provider Business Mailing Address
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Address Line | 162 SYMPHONY DR
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City | LAKE GROVE
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State | NY
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Zip | 11755-1315
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Country | US
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Telephone | 516-209-7618
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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. NICOLE JANELLE SHELLARD
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Credential | MS, OTR/L
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Telephone | 515-209-7618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 012229
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0012229
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 012229
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License Number State | NY
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