MEDICARE: MRS. ASHA MAMPILLY 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	225XP0200X	Pediatric Occupational Therapist	015052-1	NY

General Provider Information

NPI Number	:	1083924153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHA MAMPILLY OTR/L

Provider Business Mailing Address
First Line	:	7125 MAIN ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-2014
Country	:	US
Telephone Number	:	917-488-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 MAIN ST
Second Line	:
City	:	KEW GARDENS HILLS
State	:	NY
Zip	:	11367-2014
Country	:	US
Telephone Number	:	917-488-5277
Fax Number	:

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	12/07/2011

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