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General NPI Number Information
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NPI Number | 1750935896
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Entity Type | Individual
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Provider Name | YUDIS RETIG OTR
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Gender | Female
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 475 W 155TH ST
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City | NEW YORK
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State | NY
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Zip | 10032-6304
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Country | US
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Telephone | 212-690-3014
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Fax |
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Provider Business Mailing Address
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Address Line | 295 BENNETT AVE APT 3F
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City | NEW YORK
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State | NY
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Zip | 10040-2490
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Country | US
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Telephone | 610-308-4390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 023367-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 023367-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 023367-1
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License Number State | NY
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