MEDICARE: ACT ON IT OCCUPATION THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	017216	NY

General Provider Information

NPI Number	:	1023489838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACT ON IT OCCUPATION THERAPY

Provider Business Mailing Address
First Line	:	11111 76TH DR
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-7005
Country	:	US
Telephone Number	:	718-213-3041
Fax Number	:

Provider Business Practice Location Address
First Line	:	7515 MAIN ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-2420
Country	:	US
Telephone Number	:	718-213-3140
Fax Number	:

Authorized Official
Title or Position	:	OTR/L
Name	:	LEONID YAKUBOV
Credential	:	O.T.
Telephone Number	:	718-213-3041

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/26/2015

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Directions to “ACT ON IT OCCUPATION THERAPY ” Practice Location

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