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General NPI Number Information
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NPI Number | 1740509694
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Entity Type | Organization
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Legal Business Name | LIFESTYLE OCCUPATIONAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 101 1ST ST
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City | LIVERPOOL
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State | NY
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Zip | 13088-5108
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Country | US
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Telephone | 315-422-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 921 DEWITT ST #2
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City | SYRACUSE
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State | NY
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Zip | 13203
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Country | US
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Telephone | 315-422-8822
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Fax | 315-295-2125
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID P. GROVER
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Credential | OTR L
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Telephone | 315-422-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 007946
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License Number State | NY
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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 | 012318
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License Number State | NY
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