MEDICARE: JOYCE SUSAN MENDELSON 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	012045	NY

General Provider Information

NPI Number	:	1154387298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE SUSAN MENDELSON OTR/L

Provider Business Mailing Address
First Line	:	619 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4915
Country	:	US
Telephone Number	:	212-686-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4915
Country	:	US
Telephone Number	:	212-686-7500
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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