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General NPI Number Information
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NPI Number | 1912198342
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Entity Type | Organization
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Legal Business Name | GREAT NECK OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 299 EAST SHORE ROAD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11023
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Country | US
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Telephone | 516-829-4525
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Fax | 516-498-2477
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Provider Business Mailing Address
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Address Line | 299 EAST SHORE ROAD SUITE 201
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City | GREAT NECK
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State | NY
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Zip | 11023
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Country | US
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Telephone | 516-829-4525
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Fax | 516-498-2477
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST PRESIDENT
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Name | MRS. RUTH ZACK
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Credential | MA OTRL
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Telephone | 516-829-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0055861
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License Number State | NY
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