=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700692878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGE IN PLACE OCCUPATIONAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2024
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 PELHAM DR
-----------------------------------------------------
City | CORNWALL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12518-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-728-2903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 PELHAM DR
-----------------------------------------------------
City | CORNWALL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12518-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-728-2903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST/ FOUNDER
-----------------------------------------------------
Name | LAURA BALDI
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 845-728-2903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------