=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811134943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILD OT OF WESTCHESTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 01/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1075 CENTRAL PARK AVE SUITE 409
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-722-6030
-----------------------------------------------------
Fax | 914-722-6037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1075 CENTRAL PARK AVE SUITE 409
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-722-6030
-----------------------------------------------------
Fax | 914-722-6037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OT
-----------------------------------------------------
Name | KERRI NICASTRO-PALUMBO
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 914-722-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 64007240
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 014985-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 010538-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------