MEDICARE: LYDIA SAAD OTR/L

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	225X00000X	Occupational Therapist	026796	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122322471	OTHER	NY	NY DRIVERS LICENSE

General Provider Information

NPI Number	:	1033854922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA SAAD OTR/L

Provider Business Mailing Address
First Line	:	702 KATHLEEN PL APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5143
Country	:	US
Telephone Number	:	212-464-8365
Fax Number	:	347-587-1915

Provider Business Practice Location Address
First Line	:	702 KATHLEEN PL APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5143
Country	:	US
Telephone Number	:	212-464-8365
Fax Number	:	347-587-1915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/04/2022

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