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General NPI Number Information
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NPI Number | 1992065221
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Entity Type | Organization
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Legal Business Name | WEEGROW OCCUPATIONAL THERAPY, P.C.
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 300 W 135TH ST
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City | NEW YORK
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State | NY
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Zip | 10030-2731
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Country | US
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Telephone | 917-603-2385
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W 135TH ST
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City | NEW YORK
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State | NY
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Zip | 10030-2731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND DIRECTOR
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Name | DR. BRIGITTE C DESPORT
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Credential | DPS, OTR/L
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Telephone | 917-603-2385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 009959-1
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License Number State | NY
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