MEDICARE: MS. PAULINE T PETERS 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	007741-1	NY

General Provider Information

NPI Number	:	1184868077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULINE T PETERS OTR/L

Provider Business Mailing Address
First Line	:	2023 BEDFORD AVE
Second Line	:	APT.C4
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1468
Country	:	US
Telephone Number	:	718-469-0169
Fax Number	:	718-469-0169

Provider Business Practice Location Address
First Line	:	2023 BEDFORD AVE
Second Line	:	APT.C4
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1468
Country	:	US
Telephone Number	:	718-469-0169
Fax Number	:	718-469-0169

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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