=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942459383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN NICHOLAS PROWELL M.S. OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2008
-----------------------------------------------------
Last Update Date | 08/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 SPRUCE ST APT 1
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-679-3539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 SPRUCE ST APT 1
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-679-3539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 014654-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------